# Tips, Tricks, etc....



## Luno (Sep 7, 2004)

I would like to start this just to see the little tips/tricks, etc... that people have accumulated that may help us recognize symptoms/signs a little more quickly, and allow us to look beyond to what may happen in the immediate future to better construct a plan of care for our patient.  Here's a trick I learned in the field.

Pedal Edema: While it's taught that Bilateral Pedal Edema may be a sign of CHF, Pedal Edema in one leg, while the other remains unremarkable may be a sign of a Pulmonary Embolism, other signs include Tachypnea and a rapidly dropping SpO2.


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## rescuecpt (Sep 7, 2004)

For those less experienced pups, vomiting and diarrhea in a 40/50 something may be cardiac problems...  I've treated 3 men in the last 2 weeks who were exhibiting signs of a virus - vomiting, diarrhea, heartburn, weakness - who were having whopping MI's.


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## rescuecpt (Sep 7, 2004)

> _Originally posted by Luno_@Sep 7 2004, 03:56 PM
> * Pedal Edema: While it's taught that Bilateral Pedal Edema may be a sign of CHF, Pedal Edema in one leg, while the other remains unremarkable may be a sign of a Pulmonary Embolism, other signs include Tachypnea and a rapidly dropping SpO2. *


 Could also be DVT.


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## Luno (Sep 8, 2004)

While we're on AMI, females create a whole new set of problems, pts can exhibit abd px, R/L arm px, general nausea w/o other signs, back px, especially between the shoulder blades, px that changes on movement/palp, etc... Anyone else seen anything unusual with AMI?


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## shug (Sep 20, 2004)

we got a call one time C/C EAR PAIN, Obviously enough to call 911 so just on a hunch threw HER on a 12-lead... ST elivationin V1-V6,II,III,AVF and AVL.


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## Chimpie (Sep 20, 2004)

> _Originally posted by shug_@Sep 20 2004, 03:26 PM
> * ... ST elivationin V1-V6,II,III,AVF and AVL. *


 Great, now I have to go to EMT class just to decipher your post.    

(For those who are new, I'm only a MFR)

Chimp


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## rescuecpt (Sep 20, 2004)

> _Originally posted by shug_@Sep 20 2004, 02:26 PM
> * we got a call one time C/C EAR PAIN, Obviously enough to call 911 so just on a hunch threw HER on a 12-lead... ST elivationin V1-V6,II,III,AVF and AVL. *


 I've seen a lot of jaw and ear pain with female AMI, as well as headaches that last several days.


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## kyleybug (Sep 22, 2004)

> _Originally posted by Chimpie+Sep 20 2004, 06:12 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (Chimpie @ Sep 20 2004, 06:12 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-shug_@Sep 20 2004, 03:26 PM
> * ... ST elivationin V1-V6,II,III,AVF and AVL. *


Great, now I have to go to EMT class just to decipher your post.    

(For those who are new, I'm only a MFR)

Chimp    [/b][/quote]
 I know how you feel, I am new to this EMT stuff and I have a hard time reading some of these. I wish one of the "parents" would define these abbrevations for us....HINT, HINT :blink:


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## ffemt8978 (Sep 22, 2004)

> _Originally posted by kyleybug_@Sep 22 2004, 03:28 AM
> * I know how you feel, I am new to this EMT stuff and I have a hard time reading some of these. I wish one of the "parents" would define these abbrevations for us....HINT, HINT :blink: *


 EMS Acronyms


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## GFD940 (Sep 22, 2004)

Posterior MIs often exhibit themselves with just nausea, heartburn or other GI type S/S.  Unfortunately, these leads are not shown on your normal 12 lead.  Lesson here is just because the 12 lead looks good and they don't have "chest pain", don't rule out AMI yet.


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## PArescueEMT (Sep 22, 2004)

The oddest I have had was  C/C fall. Pt w/ no complaints, asked for a RMA. I talked him out of it when I got a resting pulse of 160... B/P 80/70 Resps 28 SpO2 77%
And good ol' murphy happened to be riding with me that day. I was training an EMT that was 2 days out of school.

I went with my gut, not my head (working for a private company), Called it code 3 to closest Pt. on 15 NRB w/ BVM ready, also dropped a NP due to the ETOH ingested and the history of IDDM off meds. At the hosp, PT was having issues of sinus arrest.

I still say he was lucky to be drunk since it's against our protocall to give ASA to pts at BLS care level here.


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## dgmedic (Sep 25, 2004)

> _Originally posted by shug_@Sep 20 2004, 02:26 PM
> * we got a call one time C/C EAR PAIN, Obviously enough to call 911 so just on a hunch threw HER on a 12-lead... ST elivationin V1-V6,II,III,AVF and AVL. *


 diffuse ST segment elevation is generally a sign of pericarditis.  Was there a downsloping of the PR segment?  I would have to say that if someone was having an....inferolateral-anteroseptal MI would be having some BIG pain.

-dgmedic


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## Firechic (Sep 26, 2004)

> *Posterior MIs often exhibit themselves with just nausea, heartburn or other GI type S/S. Unfortunately, these leads are not shown on your normal 12 lead. *



If you see ST depression in leads V1-V2, you can change the leads to do a V7,V8,V9 posterior placement. It's just a matter of switching a few electrodes around...wallha! You have a posterior view.
Similar to seeing ST elevation in the inferior leads and doing a V4R to rule out right ventricular involvement, especially before giving Nitro!!!


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## shug (Sep 27, 2004)

sorry  V1-V6 and AVL look at the septal wall, anterior wall and left lateral wall of the heart. II, III, and AVF look at the inferior wall :Hence: LCA be bloked and RCA not doing so hott either.


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## kyleybug (Sep 28, 2004)

> _Originally posted by ffemt8978+Sep 22 2004, 12:24 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (ffemt8978 @ Sep 22 2004, 12:24 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-kyleybug_@Sep 22 2004, 03:28 AM
> * I know how you feel, I am new to this EMT stuff and I have a hard time reading some of these. I wish one of the "parents" would define these abbrevations for us....HINT, HINT :blink: *


EMS Acronyms

 [/b][/quote]
 That was great.....I am still laughing! I still don't know the "right" codes but Iwill go ahead and study the ones posted, I think I like them better!


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## PArescueEMT (Sep 30, 2004)

how did thisthread go so far off course??? Last time I checked, it hadn't been a 12 lead class. I have been forced to sit through 3 of them so far. after the first one, it's hard to not fall asleep even when sleeping (erm... sitting) in the front row.  

Just let me know when the ACLS class starts. :lol:


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## ResTech (Oct 7, 2004)

Since most discussion so far has been on odd presentation's of AMI I thought I would put in my two cents as well. Cardiac patients for the most part present with alot of the same "classic" S/S. They're are however many patient's who are having a medical problem of a cardiac etiology who present totally off the wall so to speak and do not follow that standard text book presentation. This is where a good understanding of the pathophysiology comes in handy. 

Females and diabetics with neuropathy are two patient populations that must be carefully considered when assessing for a cardiac problem. Diabetics who have developed neuropathy usually have a decreased pain response and will not experience chest pain.  In some patient's syncope may be the only presenting symptom and the patient may have no C/P whatsoever. Don't let the absence of chest pain or a normal EKG soley dictate your course of treatment. Patients with diabetes automatically have a higher incidence of cardiovascular disease and should be weighed in while piecing together all portions of the assessment. 

Hopefully this tid-bit of info can be helpful to some of the newer EMT's on the board. So many times I have seen EMT's assess patient's who deny chest pain but show so many other good signs of a cardiac problem and completely rule out cardiac etiology.


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## Tigar (Oct 11, 2004)

here is one from last nig


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## Tigar (Oct 11, 2004)

I had one last night....transfer from local ED to larger ED 30+ miles away for CP.  55 yo M came to ED for sustrenal burning CPressure & pain in BIL arms. THis had happened 5 times over 5 days between (get this) 2000 and 2100 and would last up to 30 minutes.  The 6th night it was much worst and wouldn't stop. Then he came in to the ED.   12 lead  was normal, staff gave NTG ASA O2 (not in that order) & IVF.  Pt went to the care of a cardioloist at the BIG metro hospital.  Pts' discomfort was resolved PTOA.  POA denys CP/SOB/D(iscomfort).  Tx was uneventfull.  I was giving report to the nurse and got my signature on thr runform.  THe nurse asked if the pt was on Lipitor (or any anti-cholesterol med).  I said yes.  (i'm thinking what of it....boy I got an education real quick).....  The nurse said that pt's on anti-cholesterol meds can have burning susternal CP/Pressure and BIL Arm pain, due to......toxicity.  The nurse conversed w/ the pt as I walked out the door.  I paused when the pt said he had been on the lipitor for 5years along w/ another anti-chol med for 3 months...... (oops).  The nurse spotted me and shook his head, yes, this was the problem.  I spoke w/ our MED DIR and he had heard something about it but had yet to have a pt c/o of these symptoms.                           Go Figure.


Don't sweat the small stuff.   Everything is SMALL STUFF.


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## kyleybug (Oct 18, 2004)

Tigar,
That was very interesting. I hadn't heard of that yet either, i will however keep that in mind on the next call, and all of them there after. That is what I love about this job, there is always something new and you just never stop learning. I love it!


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## rescuecpt (Oct 19, 2004)

> _Originally posted by Tigar_@Oct 11 2004, 04:01 AM
> * The nurse said that pt's on anti-cholesterol meds can have burning susternal CP/Pressure and BIL Arm pain, due to......toxicity.  The nurse conversed w/ the pt as I walked out the door.  I paused when the pt said he had been on the lipitor for 5years along w/ another anti-chol med for 3 months...... (oops). *


 I actually had heard that somewhere, but now I can't remember where.  I think when I took my protocol update someone mentioned it.

Good catch by the nurse... wonder where he heard it from!   :lol:


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