# A-Fib?



## RedAirplane (Aug 11, 2016)

It's about 80 degrees out, and you're working a festival. You have some heat-related patients, but it's unusually cool, so you've been pretty quiet on that front.

Called out to the scene for a 40 y.o. M "not feeling well," c/o N/V and dizziness, throwing up in the trash can. Skin is flush and wet, on scene the BP is 120/P and HR is around 100.

Move him to the treatment area and he rests for a bit. After 5-10 minutes, repeat V/S are HR 52 IRR, BP 200/100. 3-lead EKG shows A-Fib. Pt and family deny any conditions and medications, except for "hypotension" or "hypertension," they don't know the difference and are not sure which one he has.

Pt ends up getting transported ALS.

What's the progression here? No Hx of A-Fib, it just showed up? Secondary to possible heat exhaustion, or is that just a red herring?

(And I'm sure something got lost, there was the whole daisy chain of ALS field unit triages to BLS field txp unit to BLS field tx area back to an ALS event medicine crew and finally an ALS ambulance... just wanted to ask about A-Fib... I'm used to it as something on the medical history, not an acute problem)


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## SpecialK (Aug 11, 2016)

Rhythm strips (3 lead ECG) are rubbish for anything diagnostic (except maybe VF, SR and asystole!).  If you think it could be a cardiac problem, do the patient (and yourself) a favour and get a proper 12 lead ECG.

Probably just transient AF secondary to another cause, if he wasn't severely compromised I'd give him no specific treatment.  I would recommend he be referred to ED and taken there by ambulance.  Alternate pathway or alternate transport not appropriate.


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## RedAirplane (Aug 11, 2016)

They probably did a 12 lead too secondary to the basic 3 lead monitoring available at the event.


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## RedAirplane (Aug 11, 2016)

RedAirplane said:


> They probably did a 12 lead too secondary to the basic 3 lead monitoring available at the event.



(Of course, not sure how that went)


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## NomadicMedic (Aug 11, 2016)

Nothing to do for this guy unless the Afib is rapid or he deteriorates en route. 12 lead, Zofran (maybe) saline lock and transport.


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## RedAirplane (Aug 11, 2016)

I guess I was a bit more curious as to what happened to cause this.


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## NomadicMedic (Aug 11, 2016)

RedAirplane said:


> I guess I was a bit more curious as to what happened to cause this.



Could be a myriad of things, but with no history and sudden onset, I'd suspect undiagnosed CAD or recent illness. Could be as simple as an electrolyte imbalance. 

http://www.secondscount.org/heart-c...uses-atrial-fibrillation-afib-af#.V6y03NjEynN


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