1EMT-P Posted January 8, 2010 Author Posted January 8, 2010 First, without looking at the 12 lead myself, this anecdotal evidence is pretty useless IMO. Is the Atrial Flutter versus SVT what the 12 lead printed out as interpretation, or was this interpreted by the paramedic? There can be a huge difference in what the 12 lead says at the top, and what is actually going on. Aside, from having a tachy HR and mild tachy RR, he " sounds " pretty stable. Did anyone think to call his cardiologist or cardiac surgeon before transfer? Respectfully, JW I am sorry, but I have to respctively disagree with you on the ancedotal evidence. A patients history & physical can tell you a lot more than a 12 lead! As I am sure you are aware Atrial Fibrillation & Atrial Flutter are fairly common among Status Post CABG patients. This patient had a history of Atrial Fibrillation & Atrial Flutter following his CABG surgery. The ED & PCP were the ones who did the interperetation of Atrial Flutter vs SVT on the 12 lead. So a patient who is 1 month S/P CABG with Atrial Flutter, palpitations & shortness of breath is stable??
Jwade Posted January 8, 2010 Posted January 8, 2010 I am sorry, but I have to respctively disagree with you on the ancedotal evidence. A patients history & physical can tell you a lot more than a 12 lead! As I am sure you are aware Atrial Fibrillation & Atrial Flutter are fairly common among Status Post CABG patients. This patient had a history of Atrial Fibrillation & Atrial Flutter following his CABG surgery. The ED & PCP were the ones who did the interperetation of Atrial Flutter vs SVT on the 12 lead. So a patient who is 1 month S/P CABG with Atrial Flutter, palpitations & shortness of breath is stable?? No offense taken. Excellent reply. I will qualify " anecdotal " as your initial post stated " YOU WERE TALKING TO A PARAMEDIC". This in and of itself makes the entire scenario anecdotal. It would be completely different if this was your patient, you looked at the 12 lead etc...... Second, Having spent 8 years as a Surgical First Assistant, I can tell you, S/P CABG patients can have these symptoms for months. They can be caused by a variety of reasons, including spasms of the graft, I have seen this firsthand looking into many open chests during my time in the Heart rooms. I am not saying one way or the other, stable or unstable due to the inherent nature of the information provided. This patient could very well be unstable, however, with the info provided in this manner, I would be hesitant to call this patient unstable and have that prompt me to push adenocard. AND, No offense, But I certainly would not allow any PCP to determine my 12 lead, I would insist on having the cardiologist on call or the cardiac surgeon who had his or her hands in the patients chest to determine this info....To each their own though! Most Respectfully, JW
1EMT-P Posted January 8, 2010 Author Posted January 8, 2010 I think you are missing the point, the patient was 1 month Status Post CABG & he developed Atrial Fibrillation & Atrial Flutter in the hospital after his surgery, he was treated with an Amiodarone Drip & 2 Grams of Magnesium IV & converted back to SR & discharged to home, three weeks later his symptoms returned. He developed palpitaions along with some shortness of breath! The patient was not in a ST, he was in Atrial Flutter!
Jwade Posted January 8, 2010 Posted January 8, 2010 I think you are missing the point, the patient was 1 month Status Post CABG & he developed Atrial Fibrillation & Atrial Flutter in the hospital after his surgery, he was treated with an Amiodarone Drip & 2 Grams of Magnesium IV & converted back to SR & discharged to home, three weeks later his symptoms returned. He developed palpitaions along with some shortness of breath! The patient was not in a ST, he was in Atrial Flutter! Trust me, I am not missing the point.... I understand he was not in ST, that is pretty easy to figure out, however, I still would NOT have pushed adenocard. Based on the anecdotal info you have provided, this patient would have been provided O2, serial 12 leads in route, depending on timeframe, possibly pain control, and I would have insisted his Cardiac Surgeon been called from his PCP's office. I still would not classify him as " Unstable" so, I would have waited to see some labs before I started him on any drips. Just because someone is in A Flutter, does not make one immediately deemed unstable.... Respectfully, JW
firemedic37 Posted January 9, 2010 Posted January 9, 2010 It seems that we all have agreed on a couple things here, pt is in A-Flutter/A-Fib, pt needs O2, IV, ECG, 12-lead and further evaluation by a physician. Would I have treated his symptoms? Who knows I was not there to see how the pt presented. Was his SOB mild or severe, does he have a new onset of CHF causing his SOB? There is much more to consider than what can be communicated easily through postings, like what did he look like? This depends on many factors, lighting, our eyes adjusting, etc. Would I of given Adenocard? I cannot say 100%. I have given Adenocard for a HR of 130 - 140 because the pt was boarderline unstable. So for us to say that we do not give Adenocard for HR's of 130 - 140, I have because the pt was boarderline unstable. We have to assess the situation each time and do what is best for that pt. There are many pt's that can tolerate a HR of 130 - 140 for days if not months before it comes an issue, then we have the ones that cannot tolerate it for any period of time.
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