firedoc5 Posted April 5, 2008 Posted April 5, 2008 I'm just going to give this scenario. I'll give the basics of what was presented, what worked, what didn't work. Give me what could have been the condition, what was done or what you would have done. This might be interesting for the "old guard" and a challenge for the new generation. 32 yr. old male. Hx complain of sore throat past few days, no dyspnea. Low grade fever. Work aholic, never went to the doc. Woke up, sore throat seems better but allergy type of breathing problems. Did morning chores. After breakfast, acute dyspnea. Sat down, EMS called but 12 minutes away. First responders find him on the floor. Resp. 16 and labored. pulse 120 Bp 140/90. Luckily one Responder recognized possible pt. crash soon. They prepared him just for that reason. Two minutes later full respitory arrest. Pulse 40, bp 70 pal. All BTLS utilized properly. Two minutes ALS arrives (myself included) Resp 0, course v-fib on monitor. CPR. Attempt to intubate. Edema noted of entire airway. Could not get through edema with blade after three attempts, twice by me, once by other medic (provisional). Take it from there.
AZCEP Posted April 5, 2008 Posted April 5, 2008 What kind of work does he do? Does he take any medications? Allergies? Epiglottitis, tonsilitis, angioedema would be my coniderations. With the amount of edema, are you able to ventilate through it at all? Surgical airway is indicated, and quickly. Might consider some nebulized epinephrine to reduce the swelling if possible.
scratrat Posted April 6, 2008 Posted April 6, 2008 Acute epiglotitis. Caridac arrest secondary to respiratory failure secondary to acute angioedema. Surgical cric with assisted ventilations. If HR doesn't improve after that, deal with it. Maybe that whole neb epi thing after cric..
irme Posted April 6, 2008 Posted April 6, 2008 Lets get some things sorted; witnessed arrsest pre-cordial thump please, get the pads on and defibrillate; start CPR post shock. Now we need to deal with the airway; what about your rescue airway? Failing this go with the cric.. Lets give epi 1mg and look at getting the Amiodarone started; Questions: ?urticaria ? lowered BP prior to arrest ? Known allergies Maybe Poison Ivey, anaphylaxsis or cellulitus
Cadet66HM5 Posted April 6, 2008 Posted April 6, 2008 witnessed arrsest pre-cordial thump please, get the pads on and defibrillate; start CPR post shock. I thought pre-cordial thump wasn't exactly recommended anymore due to most people doing it wrong or something...also wouldn't you analyze the rhythm before shocking? and are they going to not do CPR from the time he goes pulseless to the time you get you pads and monitor all set up?
AZCEP Posted April 6, 2008 Posted April 6, 2008 Precordial thump is only to be used if there is not a defibrillator immediately available. Performing this dubious value action wastes time that would be better served by applying your defib pads and shocking directly. If you witness the arrest, go ahead and shock as soon as possible. If you have to send someone to get your defibrillator, start compressions.
firedoc5 Posted April 6, 2008 Author Posted April 6, 2008 I knew it, I knew it. That was quick. Epiglottitis is a bingo. Whenever went to intubate everything looked like the inside of an oyster. Couldn't make out any land marks, especially epiglottis. Believe it or not went with the old EOA. Epiglottitis brought on by untreated strep throat and allergies. Defibed into sinus brady. Epi, atropine, lido. Anethetist actually traumatized pt. while intubating in ER. Converted back to v-fib. No save.
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