scubanurse

Uhh definitely irregular.... Did you actually measure this out or just eyeball it?!?! If you get out the calipers or even a sheet of paper you will see that the r to r interval is definitely not regular....

Would you want to treat this with a beta blocker IV or some nitro to get the pressure down then? Adenosine to slow the rate and maybe some amiodarone or lido for the dysrhythmia?

I'm just trying to work my brain on this one... I just have a very narrow experience with strokes so understanding more of the pathophys of all this can only help? Sorry

Right, but once the vessel ruptures, wouldn't the blood pressure decrease since it no long is trying to force blood past the occlusion?

But why would you then think it's hemorrhagic? http://hyper.ahajournals.org/content/43/2/137.full I always thought hemorrhagic wouldn't have a super high BP where ischemic is usually associated with hypertension.... I understand why the patient is at an increased risk for a hemorrhagic, but not why you think it is that in this case given what information is provided. Either way this patient is super sick and shouldn't be transported yet, but just trying to understand why y'all are classifying is has hemorrhagic?

So question.... why would this be hemorrhagic vs ischemic? Just based on the history of tPA? I didn't think you would see a BP THAT high with hemorrhagic. I'm not really seeing any signs of cushing's triad either indicating to me that the ICP isn't rising as it would with a hemorrhagic right?

That's awesome. It used to be my dream to wear the pink scrubs and work there. I've transported many trauma patients there and to JHU and a good friend was saved by their trauma team after a horrific motorcycle crash.

http://www.emtcity.com/topic/21024-grandpa-has-a-gun/?hl=concealed http://www.emtcity.com/topic/19942-patients-guns-and-ems/?hl=concealed

Grabbing the beers to joint arctic...I really don't have the energy for another jerk on the forum...

What/when was the last CBC, PT/INR? What rhythm does it look like at that rate? Any response to the adenosine? What dose of the adenosine? Possibility of cardioverting? Why are there no physicians in the room??? A RRT should have been called and a stroke alert at the first notice of change in symptoms...but I'm guessing this is a small hospital with no such resources which brings me to the question of why in the world would he be brought back to podunkville just 48 hours after tPA?!? He should have been in a major hospital with CT capabilities... On to care.... I'd like to get that BP down, so like IV beta blocker to get that pressure and heart rate down... Anyone else feeling like RSI and knocking this patient down for a bit? With the O2 saturation decreasing and his altered LOC, I'm not too happy with him controlling his own airway as he's stroking out and possibly going to code on us with a BP and HR that high. He's likely having another ischemic stroke (doubt hemorrhagic d/t pressure)... What meds is he on? What have his vitals trended? ETA: Any presence of corotid bruits? Patient Temperature?

Helps to read the whole post and not just jump in at the end...

WBC was wnl

Ill give you the labs I have left from my care plan... Hgb 9.5 Hct 31.6 McV 84.2 McH 25.2 Mchc 30.0 Plt 73000 K 3.7 Na 136 Cl 105 Ca 7.3 Mg 1.1 Ph 2.8 Alt 35 Ast 33 Bun 6 Creatinine 0.6 Pt 21.6 Inr 1.88 Trop 0.02 Bgl 90 Ammonia 100mcmol/L

sucks. I'm usually in chat if ya want to hang out though.

Mari got it! Check out hepatic encephalopathy

What does it even matter anymore????

Congrats

Better than my lame scenario.

Whoopdido Probably because they were copy and paste from websites or a text book...

I feel like they are copy and pasted and just a general waste of space.

That blows... Reason to just drink more.

In the mood I'm in, I'm surprised my head didn't pop off when I read that.

I don't think that is a dose supplied here OTC... here in the US 1 pill=200mg Also narcotics especially the APAP combo's carry heptotoxic risks... I think the overall point is every drug, OTC or prescribed comes with risks and shouldn't be used for longer than absolutely necessary. That's awesome! I was going to recommend getting in a pool ASAP so I'm glad you did this!

It's still an NSAID and recommended max dose is 1500mg/24hrs