Case- Chest Pain

[p3medic]

I don't know, I'm calling BS on the vagal mediated hypotension theory.....at a heart rate of 150, were is this alleged "vagal" response?

[scparamedic98]

I don't know that I would call BS on the vagal response, but it doesn't seem to go along with that diagnosis. Was the heart rate sustained at 150 or would it vary? But with the info you had and the assessment I would have treated it as a dissecting aneurysm also.

[firefighter523]

I think you need to take a manual BP. A pt in pain from a kidney stone does NOT present with a H/R of 150 and a BP of 80 systolic. Sorry.... Retake the BP, call for MS, (.1mg/kg) give it, it will help either way (kidney stone, or AAA) pending on BP.

[tonia]

I don't agree with the vagal, however triple a yes

[AnthonyM83]

I think you need to take a manual BP.

You guys have non-manual BPs in the field!? Grrr....

[Dustdevil]

I don't agree with the vagal, however triple a yes

You disagree with the CT scan?

That's a pretty bold move for an EMT. :shock:

[BushyFromOz]

You guys have non-manual BPs in the field!? Grrr....

Is the pulse rate given also from the B/P monitor?

[firefighter523]

Yep, when was the last time you've seen anyone take a manual BP in an ER. I definetely wouldn't trust them 100% though.

[fiznat]

Retake the BP, call for MS, (.1mg/kg) give it, it will help either way (kidney stone, or AAA) pending on BP.

Huh? Morphine helps with a AAA? How is that exactly?

[firefighter523]

Fiz, Usually people with AAA, have some type of hx of HTN, and, or atherosclerosis, or perhaps both. People with Marfans syndrome are also suseptable. AAAs are caused by high pressures mixed with sclerosed arteries. MS reduces preload and afterload of BP, thereby reducing the pressure placed onto suseptible arteries. It might buy them some time, but they need an appropriate diagnosis followed by immediate surgery.