Middle of nowhere

[Kiwiology]

Honestly I have no idea, showing the limits of my knowledge here!

[spenac]

Treat as an active MI based on symptoms until proven otherwise as presumed new onset LBBB could be hiding any ST elevation/depression.

[chbare]

So, we did the following;

1) oxygen 2 LPM NC

2) ASA 325 mg crushed

3) nitroglycerine 400 mcg Sl

4) metoprolol 5 mg slow IV

5) Get him the hell out

En route his pain improves to a 0/10 and you arrive safely at your destination about an hour later.

What do you want at the military hospital?

Take care,

chbare.

[spenac]

Full cardiac panel. Xray.

[chbare]

Cardiac enzymes are negative, coags are normal, d-dimer is negative, AP chest is unremarkable, CMP is normal. Patient remains symptom free.

Take care,

chbare.

Edit: WTF, two posts in one?

Edited April 19, 2010 by chbare

[joesph]

Cardiac enzymes are negative, coags are normal, d-dimer is negative, AP chest is unremarkable, CMP is normal. Patient remains symptom free.

Take care,

chbare.

Edit: WTF, two posts in one?

Stress test him? cardiac enzymes can take awhile how long after on set to blood work?

[Kiwiology]

Stress test him? cardiac enzymes can take awhile how long after on set to blood work?

I wouldn't be keen to stress test somebody who might be having an infarct as you know he migt um, die.

[DartmouthDave]

Hello,

No cath lab I assume! =)

Also, I may be overly fatigued, but are those Q-waves in V1 to V3?

Add Plavix 300mg PO, Enoxaparin 1mg/kg, change from NTG SL to IV. Maybe top up the Lopressor (5mg was given) to a total of 15mg. Review the labs (Hgb, lytes). Top up Mg and K if need be. Consult a friend.

Any way to get hands on an old 12-lead? Was one done for a medical on a civilian contractor? Not too family contractors in A'stan. I would like to know if this is an old or new BBB.

Maybe take a look with an Echo/US as well.

Any family members have MI young?

Odd that this is the first time he 'ever felt this way.' I am not saying that a patient can not have a big MI out of the blue. But, usually, they have angina, worsening SOB, fatigue, et al......before the big STEMI. Also, his age. Possible.....but not common. If her was 56.....different story.

Wait...see if the pain come back. Repeat the Troponin in 4 hours with an other 12-lead. Be conservative. If it is a STEMI treat with TNK.

Cheers

[chbare]

You can always try to evac out of country.

Repeat XII lead:

Take care,

chbare.

[Richard B the EMT]

A quick question from the BLS sector, here: is there any possibility, due to long hours flying a desk, that this patient may have Deep Vein Thrombosis, and threw a clot?