Just Plain Ruff Posted July 16, 2007 Posted July 16, 2007 You are the on duty EMS Crew for a hospital based EMS System. You are asleep in your bed and you get paged out to Radiology department for a cardiac arrest. There is a physician, a nurse and a radiology Tech in the midst of working a 42 year old male patient in cardiac arrest. Background - patient is being evaluated for dehydration and nausea and vomiting. Patient was in radiology for a chest x-ray (PA and lateral) Patient has an IV of D5NS at 125 per hour, cardiac monitor shows Asystole with good cpr spikes. Patient has been down for 8 minutes. Patient was found by the rad tech in arrest. What do you want to know and what do you want to do. All appropriate ACLS guidelines are being followed for the current rhythm of asystole
AZCEP Posted July 16, 2007 Posted July 16, 2007 2 IVs with NS/LR wide open. Secure an airway quickly, and continue compressions. Any other history (medical problems, medications, allergies) on the 42 year old? Have there been any labs drawn?
Just Plain Ruff Posted July 16, 2007 Author Posted July 16, 2007 2 IVs with NS/LR wide open. Secure an airway quickly, and continue compressions. Any other history (medical problems, medications, allergies) on the 42 year old? Have there been any labs drawn? You are able to secure an airway and continue compressions. Both iv's are established but remember you already have one started. It's a 18 ga. in the right hand Relatively healthy male patient a little overweight Meds - unremarkable other than ibuprofen and immodium for the diarrhea labs: which ones do you want?
Medic26 Posted July 16, 2007 Posted July 16, 2007 It would be nice to know a blood sugar, electrolites and what the patient looked like when he arrived. Any complaints he had that someone may have blown off, etc.
Just Plain Ruff Posted July 16, 2007 Author Posted July 16, 2007 It would be nice to know a blood sugar, electrolites and what the patient looked like when he arrived. Any complaints he had that someone may have blown off, etc. Blood sugar - 145 Electrolytes: sodium - 150 Potassium - 2.8 chloride - within normal limits c02 - 26 Calcium and phosphorous - within normal limits this is all you can get for lab values right now, due to the lab tech drawing a critical patient in the ICU. The lab tech called you with the above values though. no-one really blew off any complaints
AZCEP Posted July 16, 2007 Posted July 16, 2007 DC the D5W and replace it with LR. Dextrose containing solutions have no place in resuscitation. Any signs of drug overdose? Trauma? Breath sounds following securing the airway? Pulses generated with compressions? What's his temperature? What's the CO2 on the capnography show?
Just Plain Ruff Posted July 16, 2007 Author Posted July 16, 2007 They did not do a 12 lead - they considered this to be a case of simple nausea and vomiting. The cardiac monitor showed Normal Sinus Rythm the labs came back after he got to the Radiology department. What might have happened to this patient in the Radiology department that may have caused this guy to arrest. This actually happened to a friend of mine several years ago.
AnthonyM83 Posted July 16, 2007 Posted July 16, 2007 What's his longer term medical history like? Cardiac? Any implanted devices? Surgery scars?
Medic26 Posted July 16, 2007 Posted July 16, 2007 Potasssium is low so a k-run is in order, other than that I am stumped. Work down the H's and T's till we rule everything out.
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