the 100% directionless thread

[Anjel]

Mam/Sir...this medication may make you feel a little funny...

Haha right. So many medics I work with wont even think about treating this. Unless they absolutely have to.

 

[DesertMedic66]

What was his history Chaz? Something here smells funny.

What smells funny about a 33 y/o male with that rhythm

 

[chaz90]

Would you go straight to meds or try the valsalva maneuver first?

I did have him try Vagal maneuvers several times without effect. Before I could draw up Adenosine however, things started changing. The runs of SVT wouldn't last long enough for me to push it during the event, and I didn't want to push it on a standard sinus tachycardia. Also, I kept seeing those shortened PRI when it slowed down to 150 or so. Truthfully, we were about three minutes from the hospital with a stable patient complaining of palpitations who was, if anything, slightly hypertensive. I ended up running 500 mL of fluid into him through a big old IV and handing him over. The doc gave Lopressor and eventually discharged him from the ED with a plain Jane diagnosis of PSVT.

 

[chaz90]

What was his history Chaz? Something here smells funny.

Oh believe me, I agree. Walks like a duck, quacks like a duck, and logic says if it's not a duck, illicit pharmaceuticals are probably involved. The guy swore up and down that he didn't use any stimulants or other drugs, but he is a recovering opioid addict. One energy drink this morning (normally two per day), and history of alcoholism.

 

[Jambi]

Would you go straight to meds or try the valsalva maneuver first?

I would most likely try the valsalva first depending on how bad off they were. I try to be as least invasive as I can then work my way up.

Also, those other strips are looking like AFib with RVR or Sinus Tach with what looks like could be PAC's. There was a hint in the first one, but the others help.

Pt age? Vitals? general presentation? If the patient was stable, I'd be inclined to just sit on it and watch. It's really hard to make a clinical judgement based on ECG's alone.

 

[NomadicMedic]

What smells funny about a 33 y/o male with that rhythm

The two other strips lead me to think that this is not SVT that I want to treat with adenosine. On a quick glance, one strip looks rather irregular. Now, I'd certainly put a thousand bag into him and mellow him out in an air conditioned ambulance and watch for a sustained run of SVT (or afib with RVR) before I started mucking about with it. I also want to know his history and what he was doing before he called the amber lamps.

 

[Jambi]

I did have him try Vagal maneuvers several times without effect. Before I could draw up Adenosine however, things started changing. The runs of SVT wouldn't last long enough for me to push it during the event, and I didn't want to push it on a standard sinus tachycardia. Also, I kept seeing those shortened PRI when it slowed down to 150 or so. Truthfully, we were about three minutes from the hospital with a stable patient complaining of palpitations who was, if anything, slightly hypertensive. I ended up running 500 mL of fluid into him through a big old IV and handing him over. The doc gave Lopressor and eventually discharged him from the ED with a plain Jane diagnosis of PSVT.

It's nice to know that there are others whose though process runs like mine. I know plenty of people that would be falling on themselves to through adenosine at this patient.

Oh believe me, I agree. Walks like a duck, quacks like a duck, and logic says if it's not a duck, illicit pharmaceuticals are probably involved. The guy swore up and down that he didn't use any stimulants or other drugs, but he is a recovering opioid addict. One energy drink this morning (normally two per day), and history of alcoholism.

Dehydration and electrolytes sounds like it may have been a factor, but I assume they drew labs at the hospital and nothing was over exciting?

I like you chaz90. I've been told I'm not aggressive enough because, "there are things you could be doing." I just don't like to start tossing things into a patient that I cannot take back unless they actually need it.

 

[chaz90]

I would most likely try the valsalva first depending on how bad off they were. I try to be as least invasive as I can then work my way up.

Also, those other strips are looking like AFib with RVR or Sinus Tach with what looks like could be PAC's. There was a hint in the first one, but the others help.

Pt age? Vitals? general presentation? If the patient was stable, I'd be inclined to just sit on it and watch. It's really hard to make a clinical judgement based on ECG's alone.

33 YOM, perfectly stable. 146/98, no respiratory distress or chest pain, mild dizziness when standing. We found him walking out to the ambulance with the BLS crew. The screwy rhythms led me to sit on my hands with my med bag nearby and think furiously about doing things for the entire three minute transport. I'm pretty happy with my decision to just watch it, particularly seeing as the ED doc held off on Adenosine in favor of Lopressor. I will say that I would have probably been leaning towards Adenosine and then a consult if my transport was from one of our more distant stations.

 

[shfd739]

Posting up at fire stations again and holding down the recliners and tv?

Yes please!

 

[TransportJockey]

This has made it a long way.

 

[chaz90]

This has made it a long way.

Ha! You know those dollar bills you sometimes find with the "Where's George?" website? I'm beginning to get an idea...

 

[TransportJockey]

Ha! You know those dollar bills you sometimes find with the "Where's George?" website? I'm beginning to get an idea...

Lol I kinda have been thinking it might be cool to track a backboard as it travels

 

[RocketMedic]

That's a weird transfer.

 

[PotatoMedic]

Yeah weird transfers. Me on the other hand is off to bed so I can get up a 5 and swim before work.

 

[DesertMedic66]

This is the newest thing that I have seen posted up at my work.

 

[Aprz]

I'm adding

Walks like a duck, quacks like a duck, and logic says if it's not a duck, illicit pharmaceuticals are probably involved.

to my signature. That's hilarious!

Good idea with the backboard/George Washington idea. I'll look up the website if it's written on the backboard.

 

[NomadicMedic]

I'm 43 years old and I go to work in a big, navy blue onesie. I don't know if that's sad or totally awesome.

 

[DesertMedic66]

Fantastic, I had chickenpox as a child, I have a positive titer result for varricella, but I am still required to get the varricella shot due to clinical sites. The clinical sites want a positive titer result and proof of the vaccine <_<

 

[DesertMedic66]

I'm 43 years old and I go to work in a big, navy blue onesie. I don't know if that's sad or totally awesome.

Now I am picturing you arriving on scene of a call in a big blue onesie that is fuzzy and has little cartoon pictures on it. Best uniform ever! :rofl:

 

[PotatoMedic]

I'm 43 years old and I go to work in a big, navy blue onesie. I don't know if that's sad or totally awesome.

Want...