Bieber Posted October 22, 2012 Author Posted October 22, 2012 250ml fluid challenge see if there's any change. One post you said hr of 280, an other 180, and you keep switching between a him and a her, is it a transsexual who's having an anxiety attack because there are strangers around? I did? My bad, rate's 280. You got your IV, you're pumpin' fluid in. Waiting for that to go. =)
Curiosity Posted October 22, 2012 Posted October 22, 2012 At 280, I'm thinking less dehydration more SVT. Keep the 250 running anyways and try vagal manuver.
craig Posted October 23, 2012 Posted October 23, 2012 (edited) pads/ electrodes.....DC shock for sync. cardio version...dont stuff around people.......... 1st at 100j 2nd at 150j 3rd at 200j unsuccessful then Amiodarone 50mg (1ml) IV undiluted bolus repeat every 3 minutes whilst indication persist Max dose; 300mg (6ml) if that fails....urgent transport Edited October 23, 2012 by craig
Curiosity Posted October 23, 2012 Posted October 23, 2012 I would give adenosine a try before shocking. Less invasive. He's awake/alert. 6mg/12mg
medicgirl05 Posted October 23, 2012 Posted October 23, 2012 I would definetely give Adenosine before attempting to cardiovert.
Bieber Posted October 23, 2012 Author Posted October 23, 2012 Before we do anything, what rhythm are we calling it? And explain your interpretation if you would.
Curiosity Posted October 23, 2012 Posted October 23, 2012 Narrow complex tachy, regular rhythm, see some P waves in leads II and III, no delta waves. I'm calling it a SVT.
mobey Posted October 23, 2012 Posted October 23, 2012 Chest pain, Diaphoretic.... I'll go with 100 Fentanyl, 2.4 Midazolam and then cardiovert If that dosent work we can try 12 of Adenosine. If all else fails Amiodarone 150mg in 50ml minibag ran over 5min. I do not support wasting time trying fluids of excessive vagals with that high of a heart rate, and chestpain WITH cardiac symptoms (nausea, clammy, sweaty). Basically give them a 5ml syringe and ask them to blow the plunger out of it, if they don't slow thier rate they require further treatment.
Curiosity Posted October 23, 2012 Posted October 23, 2012 My fluid idea was based off the 180 hr. I agree, 280 is nothing to mess around with. I'm curious why cardiovert before drugs? He's maintaining a pressure. It's a dual paramedic crew, one could administer drugs while the other preps for cardiovert in case the drugs don't work. I've never seen cardioversion done at that high a rate, wouldn't it be difficult to sync? And aren't you risking a more lethal rhythm? I know if it needs to be done it needs to be done but wouldn't it be more prudent to try the drugs first? I'm sorry if these are stupid questions, it's the way I understand this, if I'm wrong, please correct me.
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