Pt had been on the computer
- Thread starter shiroun
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No cyanosis, anywhere.
At 23? Holy :censored::censored::censored::censored:. And if anything he'd been hypoventilating, he wasnt taking quick breaths, they were deep, strong, breaths. But he felt them to be shallow.
Haha that explains 90% of private ambulance people who post for 12+ hours a day and sit in a small space and don't move.
I'd say it was a clot that broke and settled into a PE then re-broke and settled elsewhere that allowed adequate blood flow, with a bad pulse reading? possible drugs but the hospital would find that out later. Otherwise I'd bank on human or device error for the pulse fluctuation. If you think about it that type of rapid change would require massive stimulation from some source that simply wasn't present. but clots seem like the most likely cause to me at least.
Aidey
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Where would the clot have settled the second time?
mycrofft
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His left hip pocket? 
I can assure you there was no human/device error in it. I'm anal about inital vitals, and theres no WAY I'd be able to screw up a pulse, besides on the stupidly high end when your head is like :wacko: trying to count.
Anyway, looks like the result is clots or an acute anxiety attack. Sounds good.
Just curious, why am I the only one thinking this?
Aidey
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You're not. This really doesn't fit a PE very well.
VFlutter
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This was my first thought as well. SVT causing hemodynamic instability and then spontaneously converting back to SR. However, in a healthy 20 year old person I wouldnt think 150s would cause that much of a problem unless there was some other underlying problem. But that is just based off personal experience, I have seen many patients remain asymptomatic until closer to 200. Then again every patient is different.
Was he by chance slamming red bulls all day? A sudden change in position can also cause SVT. Did the symptoms start when he was sitting down or after standing up? Sitting there all day causes venous stasis then he stands up all the sudden and does not get an adequate return of blood to the heart so the heart gets pissed off and goes into SVT
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SnakeDocNC
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I am not judging the EMT that ran this call just trying to provide good advice. From the description there is no way to rule out drug use because pt could fear getting in trouble so I would have reported to the nurse that pt possibly ETOH. Second with no BP its hard to tell what the heart is really doing and prove SVT without a EKG. As a general rule no matter what the pt looks like I always obtain an SPO2 reading. There are a thousand things that come to mind that could be wrong with this pt but with the info provided I want to lean to some sort of shock. Prolly would have called for ALS with the unstable vital signs.
Aidey
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Unless you have a reason beyond "the pt might be lying" to think they have alcohol on board DO NOT tell the nurse that.
Seriously.
Most nursing homes don't allow alcohol. If confused grandma tells you she hasn't been drinking are you still going to assume she might have been and is lying because she doesn't want to get trouble?
Seriously.
Most nursing homes don't allow alcohol. If confused grandma tells you she hasn't been drinking are you still going to assume she might have been and is lying because she doesn't want to get trouble?
VFlutter
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+1, you can also get yourself into legal trouble for assuming or reporting that without a probable cause not just "he is a young kid in college". What if you report that you think that patient is ETOH after a car accident just becase it is Friday night and the kid is younger? Then they pull those records for court and you are walking a fine line of getting sued if the patient was not.
There is nothing wrong with reporting the patient has ETOH odor to breath or that bystanders repot patient was drinking but just assuming is a whole mother story.
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At some point common sense seems to have been lost. Why would anyone bother to assume drug or alcohol use without some observations pointing towards it? Of course we can't rule anything out completely, but that doesn't mean that it is happening either.
SnakeDocNC
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Okay I should have worded it differently. Just because the pt. or room mate said there was no drug use doesnt mean you should not look for evidence of it. I was trying to point out that alot of times when young people are having an overdose or reaction to drugs they will not admit it due to fear of legal trouble. Report to nurse what you saw.