"He wasn't feeling well."

[zzyzx]

To answer the question about bigeminy, here's the Wikipedia entry:

"Bigeminy (Latin: Bi-Two Gemini-twins) is a descriptor for a heart arrhythmia in which abnormal heart beats occur every other concurrent beat. A typical example is with bigeminal premature ventricular beats, also known as a premature ventricular contractions/complexes (PVC). Following the PVC there is a pause and then the normal beat returns - only to be followed by another PVC. The continuation of this pairing of beats is an example of bigeminy.

These descriptors can increase depending on the number of beats involved in the abnormal system. If every other beat is abnormal, you can describe it as bigeminal. If every third beat is aberrant, it is trigeminal; every fourth would be quadrigeminal. Typically, if every fifth or more beat is abnormal, the aberrant beat would be termed occasional.

Bigeminy is contrasted with couplets, which are paired abnormal beats. If these concurrent beats number three, they are called triplets and are considered as a brief run of non-sustained Ventricular tachycardia or NS-VT.

PVC's are not the only aberrant beat that makes use of these adjectives; others are premature atrial contractions, parasystole, and escape complexes."

[zzyzx]

To answer the questions about chemical exposure and the environment: it's a warm summer day and there's nothing obvious to indicate an exposure to chemicals.

Vitals signs:

BP: 160/90

HR: 80 s/r

Lungs are clear, sats are 99% with the 02, RR of 10

Skins: warm, dry, pink

GCS: 1/1/1

Pupils are PERL

Glucose: 160

Hx of DM and HTN; meds unknown

The fire medic is starting an IV. What else would you like to do?

[WendyT]

He was having a mild heart attack/stroke.

[Just Plain Ruff]

Doesn't sound like the fire medic has done a full assessment. Seems like the bls maneuvers worked to clear up the bigeminy.

Maybe we should assist in intubating this guy

[itku2er]

BLS over ALS

I agree ruff some times its the simple things that work the best.

[Just Plain Ruff]

yes sounds like a quick jump to ALS

So what else could be wrong with this guy. Any ingestion of any sort

any medical history we need to know about.

any signs of trauma? He was found on the floor, why no c-spine?

[kitkat]

okay, I'll wade into the fray.... only because I had a similar situation the other day.

female seizure, witnessed grand mal 1-2 min (bystander time) engine on scene, pt sitting upright postical, awake, confused, tells us she feels disorientated, was incontinat of feces, NRB 10lpm / BS (normal) radials, weak/faint, tachy, FM tells me has difficulty getting BP. ( BP was 130/70 ish- Onto the stretcher we go, onto the monitor, bigeminy, long, 15 sec, settles into a sinus tach with frequent PVS's, 124-130bpm perfusing PVS's, quick 12 lead, nothing jumping out. can maybe make it into lateral ischemia in V5 if I really stretch it, does have another run of bigeminy, no change in pt status. no c/o C/P pre-post, But how reliable with altered LOC?? Bystander state 2nd seizure today, has been c/o headaches? PMHx unreliable. So.... what came first?

seizure caused arrhythmia vrs arrhythmia caused seizure? was pretty interesting, IV started, o2 contiuned monitor, and 5 min form hospital. Again reverts to sinus tach with frequent PVC.

[zzyzx]

No signs of trauma. Pt. feel onto carpeted floor. An engine company has shown up and they assist you guys in immobilizing the patient onto a backboard. Anything else you want to do before you transport? There is one thing that nobody has asked for yet.

I've given you all the vital signs and you have an IV established. The patient has an NPA in him and his respirations (about 10 per minute) are being assisted by a firefighter.

[zzyzx]

I’ll just wrap this up early since there doesn’t seem to be much interest in the scenario anymore and since anyway I’m going to be away from a computer for a few days.

This was a confusing call for us because at first we were thinking cardiac since the patient had apparently been in ventricular bigeminy. Things didn’t add up though because his skin signs were good and so was his BP. He was just totally unresponsive. He was a diabetic, but his blood sugar was also fine. We were told that he may have had some seizure activity, so that further confused things. He was way too altered (1/1/1) to just be postictal.

On the way to the hospital, which was just a few minutes away, we were thinking that his sudden collapse and continued unresponsiveness must’ve been due to a stroke.

At the hospital, they did a 12-lead and it showed ST elevations (don’t remember which leads). The computer gave the “acute MI suspected” alert. This further confused things.

I spent a little time doing my paperwork and cleaning up. When I came into the patient’s room a short while later, he was sitting there talking to the nurses. That was a big surprise and at this point I just had no clue as to what had happened to him.

As it turned out, this period of him being fully alert and oriented was only a lucid interval. They found a massive bleed on the CT and he was soon unresponsive again. I don’t know what his final outcome was.

What accounts for the ST elevations? This is something that I’ve asked about previously on this forum. Head bleeds can sometimes cause ST elevation, as well as dysrhythmias.

[Just Plain Ruff]

sounds like a quick trip to gomerville.