A call i was on yesterday

[boeingb13]

Sorry everyone about my late reply, it was DVT he threw a PE

[Just Plain Ruff]

don't let it happen again boe. The only excuse from here on out that we will accept is that you have to hunker down due to a hurricane.

[boeingb13]

I was hunkered down with work, medical sop's and a huge trauma test

[Richard B the EMT]

DVT=Deep Vein Thrombosis, a blockage in the veins. Potential for breaking off, traveling the circulatory system, and getting caught up as a new blockage causing PE, AMI, or CVA.

PE=Pulmonary Edema

CVA=Cerebral Vascular Accident, AKA Stroke. Outdated terminology is Apoplexy.

KISS Principal="Keep It Simple, Stupid!"

(Last line a reminder to myself)

[txffemtp]

...okay, so it wasn't what he was hauling even though he's SLUDGing, but a question...

how do you do bradycardia with PVCs? Aren't these normally not premature beats, but ectopic ones? I think we need to keep in mind the difference between beats coming early and those that come because a pacemaker site has failed. In my experience, PVCs usually happen at normal or slightly higher rates, whereas escape beats happen slower. Just my .02...

[firedoc5]

...okay, so it wasn't what he was hauling even though he's SLUDGing, but a question...

how do you do bradycardia with PVCs? Aren't these normally not premature beats, but ectopic ones? I think we need to keep in mind the difference between beats coming early and those that come because a pacemaker site has failed. In my experience, PVCs usually happen at normal or slightly higher rates, whereas escape beats happen slower. Just my .02...

Many times the PVC's are due to the brady. Increasing HR will tend to alleviate the PVC's.

[evjm]

Many times the PVC's are due to the brady. Increasing HR will tend to alleviate the PVC's.

So wouldn't these "PVC's" really be escape beats?

[Mateo_1387]

...okay, so it wasn't what he was hauling even though he's SLUDGing, but a question...

how do you do bradycardia with PVCs? Aren't these normally not premature beats, but ectopic ones? I think we need to keep in mind the difference between beats coming early and those that come because a pacemaker site has failed. In my experience, PVCs usually happen at normal or slightly higher rates, whereas escape beats happen slower. Just my .02...

The only symptoms that were consistent with sludge are Salivation and defecation. Organophosphate poisoning is barking up the wrong tree, at this point.

As far as terminology, a Premature Ventricular Contraction is a Ventricular contraction that occurs before the next expected "normal" heartbeat. Think of a patient in a rhythm such as Junctional Tachycardia. They are having ventricular contractions. The person then has a PVC, the PVC is called premature because it comes before the next expected ventricular contraction in a rhythm. A Ventricular escape complex is a ventricular beat that comes after an expected ventricular complex. The name of PVC is given because its origin is from the Ventricle. A ventricular contraction may originate from the Atrioventricular Node of the heart (called the AV Junction consisting of the AV Node and Bundle of HIS). This ventricular contraction would be called Premature junctional rhythm, or junctional escape rhythm.

.................................................................Escape Complex....................................

......................................................................|.........

...............................................

/__/__/__/__/__/__/__/__/__/___/_/__/__/__/__/__/__/__

..................................................................|.............

...............................................

.......................................................This is where the beat was expected..............

....................................................Premature Ventricular Complex..........................

......................................................|.........................

...............................................

/__/__/__/__/__/__/__/_/___/__/__/__/__/__/__/__/__/__

........................................................|.......................

...............................................

..............................................This is where the beat was expected.......................

[ERDoc]

The only symptoms that were consistent with sludge are Salivation and defecation. Organophosphate poisoning is barking up the wrong tree, at this point.

I would have to disagree. Given the presentation this guy needs decon. He fits an OP exposure much better than a PE. As you said, he has the salivation and defication but he also has bradycardia, hypotension, AMS/seizures. All of which are much more common with OPs than with PEs. PEs will generally cause tachycardia. They can cause either hypo or hypertension depending on the effect on the heart. It is uncommon to have mental status changes, especially seizures. The only things that argue for DVT/PE in this case is his occupational hx and the leg swelling. A PE in this case is definitely not high on the differential.

[Mateo_1387]

I would have to disagree. Given the presentation this guy needs decon. He fits an OP exposure much better than a PE. As you said, he has the salivation and defication but he also has bradycardia, hypotension, AMS/seizures. All of which are much more common with OPs than with PEs. PEs will generally cause tachycardia. They can cause either hypo or hypertension depending on the effect on the heart. It is uncommon to have mental status changes, especially seizures. The only things that argue for DVT/PE in this case is his occupational hx and the leg swelling. A PE in this case is definitely not high on the differential.

Good points doc. I have to agree with you mostly. I just felt like it was barking up the wrong tree because the answer was given to us by the OP, no matter how much things do not quite line up. Thanks for calling me on this ! I could not find text to say this, but what is the onset of symptoms from OPP from time of exposure?

Thanks.

Mateo