Chest Pain with a twist

[rock_shoes]

Why would you wait for this woman to code before you drain the fluid? You can prevent that from happening if you drain it now (though I realize you had to do what your standing orders/medical control says). This is a case where prehospital ultrasound would be great. I will admit that given the scenario, I'd be hesitant to needle her without some confirmation that she indeed has tamponade.

While technically that does fall in the allowable scope for an Alberta EMT-P there isn't a medical director I know of who would let one of us do it. The growing push toward pre-hospital ultrasound might change that.

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[mobey]

Thanks for the case! I'm a bit late, but curious. You mentioned in the initial post that the ECG showed sinus tach with a narrow QRS and no T or ST changes. Not that it is something we're normally looking for, but was there any PR segment depression?

Interesting question. Although I do not make a habit of measuring PR, there was nothing that jumped out at me.

Why would you wait for this woman to code before you drain the fluid? You can prevent that from happening if you drain it now (though I realize you had to do what your standing orders/medical control says). This is a case where prehospital ultrasound would be great. I will admit that given the scenario, I'd be hesitant to needle her without some confirmation that she indeed has tamponade.

As has been said, I don't imagine I would have gotten orders to do it while she was still alive on a risk/benefit basis. Of course I would prefer to do it as soon as I decide I can't maintain a BP anymore, but I doubt any Med Director is going to give the order. This is one of those cases that you hope for no cell service, so you can excersise the "do what's in the patients best interest" communication failure clause

Excellent case - thanks for posting....

Question - Is the pressure/pain radiating to lower back typical of tamponade? in women?

Great question! No idea....