Just Plain Ruff Posted May 15, 2007 Share Posted May 15, 2007 true but I'm leaning towards the mi but I could be wrong. Let's see what the cardiac enzymes are when he gets to the ER. Link to comment Share on other sites More sharing options...
spenac Posted May 15, 2007 Share Posted May 15, 2007 Even with my gut feeling dehydration, not ruling out MI either. Definitly need labs. Link to comment Share on other sites More sharing options...
Bombera Posted May 16, 2007 Share Posted May 16, 2007 Does this guy have a script for nitro? If so, let's give it to him. His BP is a little low so and it has dropped since our arrival on scene so I don't know if medical control will authorize nitro or not but if they do, then let's give him some. I'm with Ruffems. I think it's an MI. Let's get this guy on the road and to an ER. Link to comment Share on other sites More sharing options...
ERDoc Posted May 16, 2007 Share Posted May 16, 2007 I'm not going to jump in here, but if you are calling it a STEMI, DO NOT wait for your enzymes. Time is tissue. Call the cath lab and get the pt going. For those that are calling this am MI, assume the pt has no contraindications and you have a communications failure and cannot contact medical control; are you going to make the decision to give lytics? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 16, 2007 Share Posted May 16, 2007 I'm calling it an MI. I am also going to be following the communications breakdown and going to give the thrombos. If he has no contraindications - relative nor absolute then I'll give the thrombos. in order to do this, I have to be fully sure of my diagnosis and with elevation of leads 2, slightly in lead 3 and definately in AVF coupled wiht the atypical chest pain I'll give the thrombos. As long as I can give the rationale behind my decision to give the thrombos, signs, symptoms, and presentation along with the adjunctive devices that show MI on the 12 lead I feel comfortable giving the thrombos. I have to have a total loss of communication capabilities in order to give the med without a docs orders especially a medication like a thrombolytic. THE LOSS OF COMMUNICATION must (imperitive) be total. If there's any other way to contact medical control and I use the excuse of communications breakdown then I'm screwed. Err on the side of the benefit for the patient and do what is best. Is that what you were asking Doc? Link to comment Share on other sites More sharing options...
ERDoc Posted May 16, 2007 Share Posted May 16, 2007 I'm calling it an MI. I am also going to be following the communications breakdown and going to give the thrombos. If he has no contraindications - relative nor absolute then I'll give the thrombos. in order to do this, I have to be fully sure of my diagnosis and with elevation of leads 2, slightly in lead 3 and definately in AVF coupled wiht the atypical chest pain I'll give the thrombos. As long as I can give the rationale behind my decision to give the thrombos, signs, symptoms, and presentation along with the adjunctive devices that show MI on the 12 lead I feel comfortable giving the thrombos. I have to have a total loss of communication capabilities in order to give the med without a docs orders especially a medication like a thrombolytic. THE LOSS OF COMMUNICATION must (imperitive) be total. If there's any other way to contact medical control and I use the excuse of communications breakdown then I'm screwed. Err on the side of the benefit for the patient and do what is best. Is that what you were asking Doc? I was also asking if you have the cajones to make that decision, based on what you have. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 16, 2007 Share Posted May 16, 2007 Doc, it would be a gut decision to make. I believe that I would do it and give the medicine. I may get my arse reamed for doing it but if I felt it was absolutely the right decision to do then I would. Let me turn this around you have a medic who gave thrombos due to a communications breakdown and he brought the patient to you. He had all his ducks in a row and gave em. How would you react? Link to comment Share on other sites More sharing options...
canuckEMT Posted May 16, 2007 Share Posted May 16, 2007 Based on the presenting 12 lead I would also opt for a 15 by adding V4R and posterior V8 &V9. I would start an IV and start ASA, trial of nitro 0.4mg SL while I wait for a reply on the Cocaine hx. Is this pt a diabetic? What was his BGL? I would not jump to thrombolytics just yet on this pt, one, because we don't have that option in my area and 2, I don't believe they are warranted just yet until we get the rest of the Hx of prior events leasing up to the pain (ie: cocaine) Link to comment Share on other sites More sharing options...
scope2776 Posted May 16, 2007 Author Share Posted May 16, 2007 As your partner begins to start an IV, you ask the pt some very pointed questions about drug use and specifically the use of cocaine tonight, to which he denies. After speaking another minute about the possibility of cocaine use, you have no reason to believe your pt has taken any illegal substances. After confirming that he does in fact have no allergies you give 324 mg ASA PO. The IV (18 G angio) is patent and running at TKO/KVO. The patient does not appear dehydrated, skin turgor is good and he tells you he voided a quantity of "clear" urine before bed. Your ambulance is not yet equipped with a phlebotomy lab. He does not have a Rx for nitro and is not diabetic. Other than his father having a hx of hypertension, he has no family history. BS has not changed (90). VS are: P: 96, BP: 100/94, R: 26/labored and SpO2: fluctuates between 90/89%. You explain the seriousness of the situation and the need to be transported to the local ER. He agrees. He has no problem standing up with your help, though it does cause a slight increase in respirations, and rotating to the cot. He is strapped in and placed in Semi-Fowler's. You move the pt to your waiting ambulance. The one ER in your county is 20 min away code 3. He reports that while the CP was getting better; it now seems to be returning. His breathing rate/quality remains the same. You observe Levine's sign. And now that he's sitting in Semi-Fowler's you can make out JVD. A few questions for consensus before we continue this scenario. What transport priority? Do you want to treat for hyperkalemia, and if so how? Would you give this pt nitro and at what dose? What else are you thinking? Link to comment Share on other sites More sharing options...
Dustdevil Posted May 16, 2007 Share Posted May 16, 2007 The one ER in your county is 20 min away code 3. And... minus yet ANOTHER 5 for using local codes that most people don't use. :? What transport priority? What are our choices? Are you asking for another one of your "codes," or an actual description? Put me down for "currently stable, but potentially life threatening." I'm not driving like an arse with lights and sirens, if that is what you are asking. The difference between 20 and 22 minutes is not worth risking anybody's life over. Link to comment Share on other sites More sharing options...
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