Mark the O Posted February 2, 2010 Posted February 2, 2010 60 year old female calls for SOB. She says she ate some candy then became SOB (did not choke). shortly after that, she develops CP. vitals are all stable...no significant increase in work of breathing, lungs clear......EKG has a sinus rhythm with occassional unifocal PVC's. begin treating the pt for CP and dyspnea. on the way to the hospital the 12 lead EKG is being monitored. you see that the pt is now having some multifocal PVC's though rare. now 10 minutes prior to reaching the er the pt is now showing periods of trigeminy PVC's on the monitor. there is no change in the pt's presentation or complaints. What next............
mobey Posted February 2, 2010 Posted February 2, 2010 No, trigeminy PVC's are not an indication for any drug. Is the on 02? Unless I see couplets I am not gonna be too concerned. What is the rate? Are they perfusing?
Kiwiology Posted February 2, 2010 Posted February 2, 2010 Do you have a strip? What treatment is she on? Cardiac history? I am not concerned, PVCs can be caused by the ubiquidos 400 different things; electrolyte imbalances, hypoxia, increased sympathetic stimulation, all sorts. Treating would be appropriate in the case of circulatory compromise, prolonged coupleting or degradiation to VT or VF.
armymedic571 Posted February 3, 2010 Posted February 3, 2010 Full History and assessment to include diagnostics (BS). 12-lead ????? Oxygen, IV access, monitor. If the index of suspicion is there, transmit the 12-lead to the ED and call command for a referral.
Chief1C Posted February 3, 2010 Posted February 3, 2010 Put me on an EKG for a while and mixed in a normal rhythm, you'll see a PVC or two. I'm not treated for anything.
speedygodzilla Posted February 3, 2010 Posted February 3, 2010 I would say keeping it simple: Treat your patient not the monitor. Of course oxygen, establishing IV, etc, and be prepared if the patient becomes unstable.
DwayneEMTP Posted February 3, 2010 Posted February 3, 2010 I'm guessing that you meant that the '3lead is being monitored throughout transport to the hospital'? I don't think you've created a major faux pas if you do treat as you're probably not going to cause major issues assuming your 12 lead showed no pathologies along the normal conduction pathways, but without a decent 12 lead, I'm with the others here, no need to do much here besides try and knock them down with Os, get a good history, and transport. I see the degradation that you're worried about, but in this case, unless it's being caused by a conduction pathology or med overdose then it's unlikely she's going to get froggy on you. Good question. Dwayne
Mark the O Posted February 3, 2010 Author Posted February 3, 2010 So this particular pt had vitals all within normal ranges. I did mean 12 lead by the way. Got several of them on the way (while stopped). there was no other abnormal findings on that. Her history was somewhat troubling. she had an aortic anyerism (spelling?) that was being monitored, 3 MI's and a long list of other things. after debating wether or not to treat, I decided to be more conservative due to there being no other changes in her status (monitor changed...pt did not change). The thing that kept ringing in my head was the list of things that make PVC's dangerous....the list i learned in school 5 years ago. Multifocal PVC's, more than 6 a minute, R on T, runs of V-Tach...she was sure having more than 6 a minute. Oh and FYI, she was being treated for CP and SOB with O2, IV, ASA, Nitro and of course the EKG. other comments....................I have had several pt's like this and Im still trying to form a general idea of wether to be more aggressive or not.
WelshMedic Posted February 3, 2010 Posted February 3, 2010 So this particular pt had vitals all within normal ranges. I did mean 12 lead by the way. Got several of them on the way (while stopped). there was no other abnormal findings on that. Her history was somewhat troubling. she had an aortic anyerism (spelling?) that was being monitored, 3 MI's and a long list of other things. after debating wether or not to treat, I decided to be more conservative due to there being no other changes in her status (monitor changed...pt did not change). The thing that kept ringing in my head was the list of things that make PVC's dangerous....the list i learned in school 5 years ago. Multifocal PVC's, more than 6 a minute, R on T, runs of V-Tach...she was sure having more than 6 a minute. Oh and FYI, she was being treated for CP and SOB with O2, IV, ASA, Nitro and of course the EKG. other comments....................I have had several pt's like this and Im still trying to form a general idea of wether to be more aggressive or not. My general advice to you would be to treat the patient and not the monitor. Imagine, if you will, that you were part of a BLS crew treating a SOB pt. Would you have treated the pvc's then. NO, of course not, because they were asymptomatic and so you would have had no notion of their presence. That list of yours will stand you in good stead, I was going to post on VT salvo's but you already have the heads up there. Relax, enjoy the ride and be good to your patient. Give them what they need, not what your cookbook says.... WM. PS the word is aneurysm. 2
HERBIE1 Posted February 3, 2010 Posted February 3, 2010 Agreed with above. They may be warning signs or they may be completely benign. As was mentioned, treat the patient, not the monitor. Obviously in a patient with a cardiac condition you need to be far more suspicious of all the possibilities, but again, unless the PVC's increase, become multifocal, or the patient decompensates, don't be too worried.
Recommended Posts