p3medic Posted November 19, 2008 Author Posted November 19, 2008 IV access is achieved without difficulty. Her pulse on that arm has been weak all along, and since the BP cuff is still attached to that arm, her bp remains unchanged. She is still complaining of 10/10 chest pain...
Eydawn Posted November 19, 2008 Posted November 19, 2008 Take a BP on the other arm, for God's sake... just in case we're screwing around with time she doesn't have and could rule it out a little better! Recent pregnancies? Family cardiac history? Overuse of the hydrocodone and the heroin? Wendy CO EMT-B
zzyzx Posted November 19, 2008 Posted November 19, 2008 The other week someone told that an aortic dissection can cause a vagal response. I'd never heard of this before and didn't find anything on the internet about it. Is this for real? What is the mechanism involved?
p3medic Posted November 19, 2008 Author Posted November 19, 2008 Her blood pressure on the L arm is 168/80....with a strong pulse in that arm as well. No recent pregnancies, LMP a week ago, no change in her usual heroin/oxy usage.
Eydawn Posted November 19, 2008 Posted November 19, 2008 Ickfray! Haul ass. Get her nice and quietly into the ambulance, and then some nice high flow diesel therapy to a good surgical center with a good phone call in to tell them what's coming their way. Be ready for her to code... and get moving. Wendy CO EMT-B
p3medic Posted November 19, 2008 Author Posted November 19, 2008 Had this case yesterday morning. Yes, aortic dissection, bradycardia assumed to be secondary to compression of vagus nerve, she dissected from the root of her aorta to beyond the SMA....very impressive. Went from CT to the OR, don't have any follow up beyond that. She was managed with NTG for preload reduction and fentanyl for pain management in the field, nitroprusside infusion priot to CT. No beta blocker for obvious reasons.
zzyzx Posted November 19, 2008 Posted November 19, 2008 Vagal response due to compression of the nerve by the aneurysm...ok, that makes sense. Interesting case; thanks for sharing it.
pguy280 Posted November 19, 2008 Posted November 19, 2008 Guessinghere. Did she aspirate a seed? Depending on location and size you may only have pain without resp compromise. Birth control???
akflightmedic Posted November 19, 2008 Posted November 19, 2008 Guessinghere. Did she aspirate a seed? Depending on location and size you may only have pain without resp compromise. Birth control??? Psssttt..over here..yeh you..scenario is over.
FozMedic Posted November 19, 2008 Posted November 19, 2008 Good scenario mate, would never have thought of vagal nerve compression due to Aneurysm. Thanks for the post. :!:
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