Final exam question on heart monitor

[mobey]

Hey everyone!!

Got a case study question for ya all.

It got me arguing with almost the whole class...again.

81 y/o male MVA

Truck impacted on drivers door then frontal into tree. Pt. unrestrained lying across front seat, steering wheel is bent.

alert to voice..otherwise disoriented, inconsistantly obeys commands.

R-22 reg, Breath sounds = faint wheezes in bases, Skin pale, cool, dry, Radial pulse irregular @ 80. BP112/82 no complaints of pain.

PMHx Hypertension, and "Heart problems"

Lasix, Lanoxin, Slow k, Micronase.

Bruise on sternum, pain on left chest wall on palpation. No crepitus. ABD soft non tender, Deformity of ankle.

Question reads.."How do Karl's pre-existing problems affect your assesment?"

A: Finding the irreg pulse means the cardiac monitor must now be included in the assesment @ some point.

TRUE OR FALSE

[akroeze]

Hey everyone!!

Got a case study question for ya all.

It got me arguing with almost the whole class...again.

81 y/o male MVA

Truck impacted on drivers door then frontal into tree. Pt. unrestrained lying across front seat, steering wheel is bent.

alert to voice..otherwise disoriented, inconsistantly obeys commands.

R-22 reg, Breath sounds = faint wheezes in bases, Skin pale, cool, dry, Radial pulse irregular @ 80. BP112/82 no complaints of pain.

PMHx Hypertension, and "Heart problems"

Lasix, Lanoxin, Slow k, Micronase.

Bruise on sternum, pain on left chest wall on palpation. No crepitus. ABD soft non tender, Deformity of ankle.

Question reads.."How do Karl's pre-existing problems affect your assesment?"

A: Finding the irreg pulse means the cardiac monitor must now be included in the assesment @ some point.

TRUE OR FALSE

TRUE

I would go further and say MOI indicates the need for a rhythm strip.

[EMS49393]

Both answers are somewhat incorrect. Your patient is on Lanoxin which is commonly prescribed in patients with A-fib. This patients heart rate may indeed be irregular, however it may always be irregular. That in and of itself is not a cause for alarm. Lanoxin decreases the conduction through the AV node, thus decreasing the heart rate. Now you have a patient that is not going to become tachycardic even though they are in shock. That is your answer.

[nsmedic393]

Good call 393. Although we can establish a pre-existing hx of a-fib obviously its warranted to print off a strip but not necessarily alarming.

[bf1511]

I agree the monitor would be a good idea because of the MOI and complaint. It will not give us a definite answer but may assist in the long run.

Now the next question, whats up with the altered LOC. You mention nothing about any head injury or other Hx to lead toward altered LOC except an Rx of micronase. Hypoglycemia may also lead to irregular heart beat. I have had patients with hypoglycemia show a perfect A-fib then resolve with glucose. I know its a stretch but worth thinking about.

The key thing to remember is the monitor is just like everything else, a tool out of the box. All tools are used when you think you need them. If you have a suspicion and need to use a tool, use it. It shouldn't start any arguments about when to or not to do it.

[mobey]

My argument is whether or not an irregular rythm is present or not, an 81 y/o in an unexplained MVA, with a chest injury is gonna get a monitor @ sometime. We have no idea why this accident occured, hypoglycemia, seizure, syncope episode d/t poor preload... But if I am not sure I want to look at all the systems, Irregular pulse or not.

So I unlike some of the other students say FALSE

[paramedicmike]

Who's Karl and how does he play into all of this?

[mobey]

The pt.

[tjems]

Hi Everyone....just another student from the class he is in, and on the other side of the page on this question. Finding an irregular pulse in a trauma pt. would then give me more reason to include the cardiac monitor in my assessment. This pt. is a load and go, because of altered LOC, and I would include the monitor once I was in the unit and on the way. An irregular pulse may be normal for this pt. with his given history, but I would like to gather all the information I can, including a strip. Finding the irregular pulse on your primary assessment IS a reason to include the monitor sooner than later.

Any other views on this?

Tj

[mobey]

I think we may be agreeing!!!

I concur with your statement, it is more reason to include the monitor. However a irregular pulse in this situation is not the ONLY reason for the strip like the question implies.

Peace

Mobey