HellsBells Posted April 24, 2012 Author Posted April 24, 2012 He went to Mcdonalds for lunch, ate with his co-workers in the restaurant.
mobey Posted April 24, 2012 Posted April 24, 2012 OK, Ill pull the trigger. I have enough history to shock this dude. Sync Cardioversion at 200J please.
Asysin2leads Posted April 24, 2012 Posted April 24, 2012 Stimulant related hyperpyrexia and/or cocaine washout. Board and collar to be sure, strip down to skivvies, turn on air conditioning in the back. Rapid transport. Begin large bore infusion 0.9%, recheck vital signs after 250 cc bolus. Depending on temperature, distance to hospital, etc., more aggressive cooling methods may be necessary. Look for signs of electrolyte imbalance in EKG, peaked or flattened T's, etc. I helped the ER on a case similar to this, a man had passed out after cocaine usage at a construction site, was not discovered for over three hours in 90 F heat with high humidity, his temp was over 107 degrees F. I got to do the 100 yard dash down to the cafeteria for bags of ice as the ER set up the collapsible tub. I didn't even know such a thing existed until then. I don't think adenosine or cardioversion is going to help, but you can always try. What might help is if you give him the benzos, you'd have to convince medical control, but i know benzos are used to mitigate stimulant related tachycardias. But really this guy needs access to more differentials than we can provide, a tox screen, for one. I'm willing to bet it would come back positive for cocaine or methamphetamine, usage of which can be higher among people who work menial level construction jobs.
mobey Posted April 25, 2012 Posted April 25, 2012 Stimulant related hyperpyrexia and/or cocaine washout. Board and collar to be sure, strip down to skivvies, turn on air conditioning in the back. Rapid transport. Begin large bore infusion 0.9%, recheck vital signs after 250 cc bolus. Depending on temperature, distance to hospital, etc., more aggressive cooling methods may be necessary. Look for signs of electrolyte imbalance in EKG, peaked or flattened T's, etc. I helped the ER on a case similar to this, a man had passed out after cocaine usage at a construction site, was not discovered for over three hours in 90 F heat with high humidity, his temp was over 107 degrees F. I got to do the 100 yard dash down to the cafeteria for bags of ice as the ER set up the collapsible tub. I didn't even know such a thing existed until then. I don't think adenosine or cardioversion is going to help, but you can always try. What might help is if you give him the benzos, you'd have to convince medical control, but i know benzos are used to mitigate stimulant related tachycardias. But really this guy needs access to more differentials than we can provide, a tox screen, for one. I'm willing to bet it would come back positive for cocaine or methamphetamine, usage of which can be higher among people who work menial level construction jobs. This is the road I was originally on as well. Thought even a SSRI overdose..... Then I noted he was not hyperthermic. I suspect you missed that? I am on the cardiac train now.
DFIB Posted April 25, 2012 Posted April 25, 2012 I will be happy to carry Moby's bag from here on out.
Arctickat Posted April 25, 2012 Posted April 25, 2012 I don't think adenosine or cardioversion is going to help, but you can always try. What might help is if you give him the benzos, you'd have to convince medical control, Wouldn't have to convince anyone here, Versed is recommended prior to cardioversion, so I could do both.
mobey Posted April 25, 2012 Posted April 25, 2012 Wouldn't have to convince anyone here, Versed is recommended prior to cardioversion, so I could do both. Being as hypotensive as he is, benzo's are a no-no in my books. To reach the sedation dose required for cardioversion, we will end up decreasing his BP even further, and feed that tachycardia through baroreceptor feedback. If anything, this guy would get Ketamine, or Fentanyl.
HellsBells Posted April 25, 2012 Author Posted April 25, 2012 Ok mobey lets cardiovert at 200, 300, 360... no effect, lets even try adenosine @ 12mg... no effect Since asys mentioned it, lets try versed- 5mg... some small reduction in moaning BP rises to 100/70 following 1000ml fluid repeat vitals hr- 188 bp 100/70 resp 24 shallow temp 39*C- A/C on, ice packs applied gcs 3 02 sat 94% on oxygen
Kiwiology Posted April 25, 2012 Posted April 25, 2012 (edited) I have absolutely no idea but his cause for unconsciousness is not rapidly improving and his SpO2 is consistently low so I am thinking about anaesthetising, paralysing and intubating him. Edited April 25, 2012 by Kiwiology
Just Plain Ruff Posted April 25, 2012 Posted April 25, 2012 I have absolutely no idea but his cause for unconsciousness is not rapidly improving and his SpO2 is consistently low so I am thinking about anaesthetising, paralysing and intubating him. There you go again, wanting to drop that tube down the guys Gob
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