rock_shoes Posted February 24, 2014 Posted February 24, 2014 ecg1web.jpg Oh and here is the requested 3-lead and 12-lead Quakefire, Are you guys doing pre-hospital fibrinolytics out in Saskabush when you're too far out to make a cath lab window? In the mean time, initiate transport as soon as you have a line in place, start a fluid challenge (500mL checking lung sounds and vitals every 250mL), prep your dopamine (might just need it here), put on the pads, and get moving to the closest cardiac receiving hospital because there isn't a thing the little community hospital is going to do you can't consult a cardiologist and do on route (unless of course they can push fibrinolytics and you don't in your area).
paramedicmike Posted February 24, 2014 Posted February 24, 2014 (edited) BGL 6.8 mmol/L (122.4 mg/dL) BTW, while I know how to do the conversion, +1 for saving me from doing the math this morning. Edited February 24, 2014 by paramedicmike
Quakefire Posted February 24, 2014 Author Posted February 24, 2014 The fall as described to dispatch was when the patient dropped herself onto the bed, no syncope. No prehospital fibrolytics yet supposed to be in the pipeline. Also no pressors except for severe sepsis Home hospital is 20 minutes away, Lab, X-Ray, ECG "Big City Hospital" is 40 minutes away, Cardiac specialty, Cath lab, Cardiac Sx and CCU. This hospital has a STEMI alert protocol Of course two hospitals are in opposite directions so transfer time is 60min. Rotary wing is not available at this time
paramedicmike Posted February 24, 2014 Posted February 24, 2014 Big city hospital with cardiology capabilities here we come.
Just Plain Ruff Posted February 24, 2014 Posted February 24, 2014 yep, big city on the way. Do we have the ability to get a third person to ride with us just in case we need em? Be nice to have a second set of hands when this lady decides to shit the bed on us35 minutes out.
Quakefire Posted February 24, 2014 Author Posted February 24, 2014 Ok, to consolidate everyones treatment We are now enroute to the Cardiac Center, about 40 minutes transport, we have O2, a NS line, 3-lead and 12 lead, and quick combos in place. STEMI alert has been called. Haven't seen a interpretation of the 3-lead, and no one has has actually said what kind of MI the 12 lead shows And just you in the back, in the event that she goes into arrest, you have access to a Zoll Autopulse.
rock_shoes Posted February 24, 2014 Posted February 24, 2014 Ok, to consolidate everyones treatment We are now enroute to the Cardiac Center, about 40 minutes transport, we have O2, a NS line, 3-lead and 12 lead, and quick combos in place. STEMI alert has been called. Haven't seen a interpretation of the 3-lead, and no one has has actually said what kind of MI the 12 lead shows And just you in the back, in the event that she goes into arrest, you have access to a Zoll Autopulse. Sinus bradycardia with a rather significant first degree block. ST changes in II, III, aVF along with reciprocal changes in the precordial leads are indicative of an inferior MI. A 15 lead including V4r, V8, and V9 would be prudent (especially prior to even considering any nitrates). Nitrates in the event of suspected inferior MI are controversial with some EMS services advocating very careful administration and other services considering it a contraindication.
Just Plain Ruff Posted February 25, 2014 Posted February 25, 2014 Ok, to consolidate everyones treatment We are now enroute to the Cardiac Center, about 40 minutes transport, we have O2, a NS line, 3-lead and 12 lead, and quick combos in place. STEMI alert has been called. Haven't seen a interpretation of the 3-lead, and no one has has actually said what kind of MI the 12 lead shows And just you in the back, in the event that she goes into arrest, you have access to a Zoll Autopulse. I believe one of my posts said elevation in 2, 3 and AVF
Quakefire Posted February 25, 2014 Author Posted February 25, 2014 I believe one of my posts said elevation in 2, 3 and AVF I did see that, just looking for a diagnosis from that. Any further treatment?
Just Plain Ruff Posted February 25, 2014 Posted February 25, 2014 I did see that, just looking for a diagnosis from that. Any further treatment? no worries, Yeah inferior MI, I didn't fully flesh out my thoughts as I was posting on my work computer and they frown on me being on the web at work. But I'm a rebel, I'm on it now at work. Booyah!
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