# Appendicitis.... Cardiac issue



## Chris EMT J (Oct 25, 2022)

So this is a wild one a few sma changes for patient privacy. 

14 y/o female cc of ABD pain 

ABC: airway clear and protecting, breathing effort normal with no difficulty, circulation okay on appearance and mental status= A&O x 4

Sample:
ABD pain, specifically RLQ, sharp, w/ hip radiation
Allergic to penicillin based medication

Daily aspirin (doctor recommended) 

History of unknown arrhythmias (parents didn't remember the name) 

Last oral intake was a sandwich

Events leading was just reading a book

Original vitals:
HR 115 (sinus) BP 168/91 O2 92% RR 12 BGL 140 and temp 98.7f 

ECG preformed due to cardiac history which was normal sinus tachycardia 

Mc Burney point positive

Transport started for possible appendicitis heading to a children's hospital less then 10min

Breathing sounded clear so started on 3lpm NC 

Then medic told me to pull over and stop moving then I heard him use his side radio "patient CPR in progress" and he yelled drive so I started driving faster and I heard the lotus CPR machine and we arrived then the medic went in I parked and went in and medic was giving report while the room was full of people. We left shortly after and CPR was still in progress. Any ideas?


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## mgr22 (Oct 25, 2022)

I'm going to guess she had a sudden, severe bleed -- e.g., ruptured ectopic pregnancy.


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## NomadicMedic (Oct 25, 2022)

Yeah, abdominal pain for a female of child bearing age, leading to arrest? Ectopic.


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## Chris EMT J (Oct 26, 2022)

Ectopic is something I didn't think about but now that I am that sounds like a good possibility.


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## Tigger (Oct 26, 2022)

Ectopic pregnancy at the top of the list sure, but this could be literally anything. Go talk to your CES or QA people, they can get you some actual followup. This is just a guessing game.


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## E tank (Oct 26, 2022)

Tigger said:


> ...this could be literally anything. Go talk to your CES or QA people, they can get you some actual followup. This is just a guessing game.


Agreed...what did the paramedics history and physical reveal? LMP? GYN hx? Lots there that will raise or lower index of suspicion and should be a routine consideration on these kinds of calls....would be very unusual for a ruptured to present with a full arrest. If the patient didn't appear ghostly blanched white if Caucasian or just grey with white mucous membranes of any other race, odds are low that was a hypovolemic arrest.


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## Chris EMT J (Oct 26, 2022)

I did finally figure out how I can get the update so the update is patient had a ruptured aneurysm from a birth defect on the hepatic artery.


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## Chris EMT J (Oct 26, 2022)

Chris EMT J said:


> I did finally figure out how I can get the update so the update is patient had a ruptured aneurysm from a birth defect on the hepatic artery.


Forgot to add that patient also had appendicitis


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## mgr22 (Oct 26, 2022)

Chris EMT J said:


> Forgot to add that patient also had appendicitis


Wow, some case -- a good reminder about multiple etiologies.


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## Aprz (Oct 29, 2022)

Chris EMT J said:


> I did finally figure out how I can get the update so the update is patient had a ruptured aneurysm from a birth defect on the hepatic artery.


Probably the most important update... did she survive????


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## silver (Oct 29, 2022)

The daily ASA in a pediatric patient should get you thinking that this person has a serious chronic illness (eg. hx congenital heart disease with some conduit/shunt, prior stroke, stent, vasculitis/Kawasaki disease).


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## Chris EMT J (Oct 30, 2022)

Aprz said:


> Probably the most important update... did she survive????


Yes they got Return of spontaneous circulation and this case was a little bit ago so I should be allowed to say that after about a 2wks and a half I was able to do a IFT from hospital back home


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## Chris EMT J (Oct 30, 2022)

silver said:


> The daily ASA in a pediatric patient should get you thinking that this person has a serious chronic illness (eg. hx congenital heart disease with some conduit/shunt, prior stroke, stent, vasculitis/Kawasaki disease).


The history of daily aspirin+ arrythmias unknown we suspected a congenital cardiac disease


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## mgr22 (Oct 30, 2022)

Chris EMT J said:


> The history of daily aspirin+ arrythmias unknown we suspected a congenital cardiac disease


With a complaint of RLQ pn? Why?


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## Chris EMT J (Oct 31, 2022)

mgr22 said:


> With a complaint of RLQ pn? Why?


We were trying to guess what the pmx was not the differential for the presentation


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## johnrsemt (Nov 10, 2022)

Wow, when you run into Zebra's you get the entire herd don't you.  lol


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## Summit (Nov 10, 2022)

Interesting. First time reading the thread. Eyebrows went high on that daily ASA. Glad she made it.


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## Chris EMT J (Nov 18, 2022)

Summit said:


> Interesting. First time reading the thread. Eyebrows went high on that daily ASA. Glad she made it.


Yeah haven't seen any kids on daily aspirin before


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## Martyn (Nov 19, 2022)

Chris EMT J said:


> Yeah haven't seen any kids on daily aspirin before


Change of subject (I know) but I transported a 2 yr old male on Viagra once so a 14 yr old on ASA don't raise my eyebrows lol


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## Akulahawk (Nov 21, 2022)

mgr22 said:


> With a complaint of RLQ pn? Why?





Chris EMT J said:


> We were trying to guess what the pmx was not the differential for the presentation


RLQ pain / positive McBurney’s point definitely speaks to an appy. Asking about meds got the ASA as a daily med. That is not usual so… good on the crew to keep their suspicion elevated. The rapidity of losing pulses usually means something popped. Proximity to the hospital and fast recognition of the new problem probably led to a  reasonably good outcome.


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