zzyzx Posted August 14, 2007 Posted August 14, 2007 It's late afternoon and you're almost done with your shift when you respond to a fall victim, the third one today. You're quite suprised when you walk in and find your patient, a 40-something y/o male, supine on the ground with snoring reps. A firefighter is just starting to bag the patient and the fire medic, who's been on scene just a few minutes before you, says, "Hey, he was in bigeminy when I first got here. His wife said she heard him collapse after he came in from working in the garage saying that he wasn't feeling well."
zzyzx Posted August 14, 2007 Author Posted August 14, 2007 Your patient is a 40-something y/o Hispanic male with a history of diabetes and hypertension, meds unknown. Your initial impression: A: the fire medic has tried to intubate but the patient still has a gag reflex. B: 10-12. Patient is now being bagged by a firefighter. C: skins are warm, dry, pink You glance at the monitor and see a normal sinus rhythm at 80. The fire medic has told you that he was initially in bigeminy.
Richard B the EMT Posted August 14, 2007 Posted August 14, 2007 ..."bigeminy"... Wozzat? (I suspect I may be kicking myself when the answer is published)
vs-eh? Posted August 15, 2007 Posted August 15, 2007 1) What was the blood sugar obtained prior to attempting to intubate this "snoring resp" diabetic patient. I seriously hope one was obtained prior to attempting to intubate this patient... 2) What type of bigemeny was this patient in? If it was ventricular, were the PVC's conducting? 3) BLS airways maneuvers and oxygenation seem to have cleared up the ectopy. I'm gonna go out on a limb and say the patient is hypoxic secondary to carbon monoxide poisoning... What do I win?
zzyzx Posted August 15, 2007 Author Posted August 15, 2007 His blood sugar is 160. :wink: He was in ventricular bigeminy. Fire medic doesn't know if the PVC's were producing pulses. Wife says he was just doing woodworking in his garage--no carbon monoxide. What else would you like to know?
letmesleep Posted August 15, 2007 Posted August 15, 2007 OK, what the hell I'll bite. what about his v/s? I'd really like to know what the outside temp has been, and was the day of the event. does he have any known exposures?
Richard B the EMT Posted August 16, 2007 Posted August 16, 2007 Could SOMEBODY please tell me what "bigeminy" is, I'm dying from the suspense?
BEorP Posted August 16, 2007 Posted August 16, 2007 Could SOMEBODY please tell me what "bigeminy" is, I'm dying from the suspense? I believe it is when every normal beat is followed by a PVC.
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