perimeter Posted December 2, 2013 Posted December 2, 2013 You are called to a residence at 2000 hours for a patient experiencing chest pain. Upon arrival, you enter the residence and find a 73 year old patient laying on his bed in obvious distress. The pt. is awake and alert. Describes 9/10 substernal chest pain of sudden onset. He has a history of triple bypass surgery and took one baby aspirin prior to your arrival. Pt. doesn't take any other meds regularly. He is diaphoretic and has a rapid, strong, radial pulse. He is moved to the stretcher and expediently to the ambulance. V/S are taken and reveal 122/92, heart rate 160, respirations 16 nonlabored. Cardiac monitor is placed and V-Tach is shown on the monitor. Treatment?
island emt Posted December 2, 2013 Posted December 2, 2013 (edited) DO your own homework research and come back & tell us the answers. We'll let you know what we think. PS: Once you've been in the field for a while you'll learn nothing is done expeditiously or forthwith. Edited December 2, 2013 by island emt 1
perimeter Posted December 2, 2013 Author Posted December 2, 2013 It's not homework, actual call a few weeks ago. As soon as I got the monitor hooked up I had my partner initiate transport emergency traffic to the ER. I will tell you what I did en route, but I was hoping to hear how others would have treated. 1
perimeter Posted December 2, 2013 Author Posted December 2, 2013 (edited) Don't have propofol on the truck. Also, no IV access. Transport time is approximately 7 minutes to closest ER. EDIT: For the sake of argument, let's say you can't establish IV access after 3 attempts. Edited December 2, 2013 by perimeter
paramedicmike Posted December 2, 2013 Posted December 2, 2013 It's not homework, actual call a few weeks ago. As soon as I got the monitor hooked up I had my partner initiate transport emergency traffic to the ER. I will tell you what I did en route, but I was hoping to hear how others would have treated. Ok. So tell us what you did and we'll tell you what we think.
perimeter Posted December 2, 2013 Author Posted December 2, 2013 Ok. So tell us what you did and we'll tell you what we think. Ok. I gave oxygen via NC, placed pacer/defib pads, continued to attempt IV while keeping an eye on the monitor and his level of consciousness for any changes. Transport time was approximately 7 minutes to ED. IVs were unsuccessful. I guess my main quandry is whether or not you would have cardioverted him.
scubanurse Posted December 2, 2013 Posted December 2, 2013 What was his LOC? BP looks good for now but with out knowing how he was mentating I'm not sure yet.
paramedicmike Posted December 2, 2013 Posted December 2, 2013 Just to clarify are you a paramedic student? Or are you a paramedic? Have you taken ACLS yet? Answers to these will help frame answers from here on out. What was your impression of this guy? Was he sick? Or not sick? Stable? Not stable? You decided not to cardiovert him. Why? What was your thinking?
Kiwiology Posted December 2, 2013 Posted December 2, 2013 (edited) I would not cardiovert him unless he became very compromised. In NZ EMTs have automated cardioversion, Paramedic and ICP have manual cardioversion; ICP also has midazolam/ketamine. If I couldn't get IV access that wouldn't stop me cardioverting him. I'd rather be alive and have a sore chest than be dead. Edited December 2, 2013 by Kiwiology
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