Dispatched to 16 y/o F Unknown

[Bombera]

More questions: Is this young lady bleeding from her vagina? Is she using a tampon?

Has she been throwing up lately? If so, was there hematemesis? Has she had any diarrhea? Is she hydrated?

What does the ECG look like?

Does her SpO2 improve with the O2 via NRB?

Has she recently had an infection of any sort?

I would want to transport this girl quickly as she seems to be showing some signs of shock of some sort.

Take care,

Bombera

[ERDoc]

Keep in mind that there are very few things that makes someone this tachycardic.

[Bombera]

ERDoc, you have a real point. The last time I saw someone's heart beat that fast, I had to do CPR because the guy was in V-Tach. I would like to see a 12 lead on this girl right away and get her transported like yesterday.

[Timmy]

Sometimes some good old fashion reassurance works well in situations like this.

I agree, something’s up!

This 'nurse' didn’t happen to be the Lab assistant with a first aid cert lol??

[canuckEMT]

It sounds to me like the underlying problem is the rate, but I would not rule out a PE either at this point.

Keep her on high flow O2, also try to gain hx of same episode previous? Even though she has no prior medical hx, she could have had prior episodes that spontaneously resolved.

I would also want a 12lead, but in the unit to remove her from the stress of the ( so understanding school nurse and principal) and question again about rec drugs or stimulants lately. Then enroute, vagal maneuvers, IV 18 ga in the left AC while trying to coach breathing. I would also get the EMT to hook up the nasal ETC02 under the NRB to see the waveform.

Other tx's will wait to see what the ECG looks like.

[Just Plain Ruff]

I'm leaning towards a blood clot - PE secondary to birth control pills.

[scope2776]

A focused exam reveals no signs of pregnancy and you have no reason to believe she is pregnant, other than the fact she is on birth-control.

The patient seems to be slowing her breathing and is now somewhat diaphoretic. She is also becoming increasingly drowsy, you have to repeat some of your questions twice and speak a little louder.

You ask is she has thrown up or had a fever recently, she replies "no". Skin turgor is normal. You ask her if she has ever had difficulty breathing or palpitations before to which she replies, "no".

You listen to lung sounds as your EMT partner gets the new ETCO2 detector out. Lungs are clear, bi-lat and labored from what you can tell; with such diminished tidal volume. No adventitious sounds.

You work to calm down the girl's breathing with therapeutic communications. Your attempts at vagal maneuvers, such as bearing down or blowing on a syringe, are worthless because the patient cannot hold her breath or work at anything other than breathing for more than a couple of seconds.

The capnography nasal cannula is placed under the NRB mask and reads 45. The waveform is tall but does not show a "shark-fin".

The nurse asks, "what's all this fuss about! She's just hyperventilating!" The young woman seems to become more agitated while you perform your interventions.

You ask your partner to start an IV (18G angio) of NS at TKO/KVO. As he begins this you place the patient on a 3-Lead. You see a wide complex tachycardia at roughly 300 BPM. You then decide to do a 12-Lead:

VS are as follows: P: roughly 250-300, BP: 86/56, R: 26, SpO2: 87%, ETCO2: 45. Using your Paramedic super-power you guess her weight to be about 40 kg.

Treatments? Working diagnosis? Do you want to "load and go" or "stay and play"?

[Dustdevil]

Are the police there?

I'm no longer amused by the presence of this "nurse."

Nor the principal either.

[scope2776]

A single police officer arrives and is available as needed.

[p3medic]

sedate with versed, synchronized cardioversion.....repeat prn I'm calling it an svt with LBBB, but its semantics, tx doesn't change. she's unstable, i'm not waiting to infuse amio, she's not getting a ccb, I might consider 6 of adensosine just prior to my versed.....nurse is in for a treat!