# Post Op tachycardia



## txilemt (Apr 21, 2013)

23 yo female complaining of tachycardia and a very "uneasy" feeling that comes in waves. Pt had surgery 5 days prior for tib/fib fracture from MVA. On arrival pt is AO and not in resp distress. Color is good. Pulse 130, BP 156/104, res 14, Sp02 98%. Woke up around 10 am took meds: injectable blood thinner, antibiotic, and tramadol. Pt only had donut for breakfast. (We arrived at 1115). Pt stated she smoked a small ammount of marijuanna when she first woke up but said it didnt affect her at all. Got pt in rig. During 40 min transport pt vitals would jump up every 5 mins or so for about a minute. Vitals jump from: pulse-94-130, BP 134/87-160/108 and pt would tense up and complain of "uneasy" feeling. No respiratory issues but I did place her on a NRB at 15 lpm for comfort and to help with nausea. Said it helped. Complained of numbness in left arm once or twice then said it was better. Consistently went through these "waves" the entire trip. Was this a reaction to the meds on an empty stomach? Something worse? PE? Lung sounds were clear. Workinh herself up?Just a nag in my mind. Thanks


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## VFlutter (Apr 21, 2013)

txilemt said:


> 23 yo female complaining of tachycardia and a very "uneasy" feeling that comes in waves. Pt had surgery 5 days prior for tib/fib fracture from MVA. On arrival pt is AO and not in resp distress. Color is good. Pulse 130, BP 156/104, res 14,* Sp02 98%*. Woke up around 10 am took meds: injectable blood thinner, antibiotic, and tramadol. Pt only had donut for breakfast. (We arrived at 1115). Pt stated she smoked a small ammount of marijuanna when she first woke up but said it didnt affect her at all. Got pt in rig. During 40 min transport pt vitals would jump up every 5 mins or so for about a minute. Vitals jump from: pulse-94-130, BP 134/87-160/108 and pt would tense up and complain of "uneasy" feeling. *No respiratory issues but* *I did place her on a NRB at 15 lpm for comfort and to help with nausea. *Said it helped. Complained of numbness in left arm once or twice then said it was better. Consistently went through these "waves" the entire trip. Was this a reaction to the meds on an empty stomach? Something worse? PE? Lung sounds were clear. Workinh herself up?Just a nag in my mind. Thanks



Using 15L NRB is an inappropriate use of oxygen. There is no indication for oxygen. There is no strong evidence that oxygen reduces nausea. If you would have put her on 2L NC for "comfort" I would not agree with it but I would not make a huge deal about it either but 15L NRB is not indicated at all. 

Was her pain controlled? 5 days s/p fx repair, most likely ORIF, is still pretty fresh and would most likely have significant pain that Tramadol may not adequately control. 

PE is a concern with post op ortho patients but she is on Lovenox and her symptoms don't fit. 

Taking Abx and Tramadol on an empty stomach and then smoking marijuana is probably the cause of the nausea and uneasy feeling. Maybe some anxiety and acute pain as well. Given the patients age and situation I am not overly concern with the HR or the vitals.


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## chaz90 (Apr 21, 2013)

Chase said:


> Really? Totally inappropriate use of oxygen and a medication error. If you would have said you put her on 2L NC for "comfort" I would just roll my eyes but 15L NRB is just ignorant. You most likely did more harm then good. Also, please provide me with research that oxygen relieves nausea. I'll give you a hint, there isn't.



This seems a bit harsh. I'm certain most on this site agree with everything you're saying, but let's not attack someone who could be a very new EMT. The OP did after all do what most EMT-B classes sadly teach and what many protocols still require. We need to be advocates for change at the educational level rather than jumping on anyone for doing what they were taught and what they thought was in the patients best interest.

I completely agree with the rest of your post though.


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## VFlutter (Apr 21, 2013)

chaz90 said:


> This seems a bit harsh. I'm certain most on this site agree with everything you're saying, but let's not attack someone who could be a very new EMT. The OP did after all do what most EMT-B classes sadly teach and what many protocols still require. We need to be advocates for change at the educational level rather than jumping on anyone for doing what they were taught and what they thought was in the patients best interest.
> 
> I completely agree with the rest of your post though.



Thank you. That did come off a little harsher than I intended so I edited it. It is one of those topics that is very frustrating once you truly understand the physiological effects of our interventions and in many case the potential harm we may cause because of outdated myths and protocols.


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## Akulahawk (Apr 21, 2013)

This, to me, sounds a lot like poorly controlled pain or poorly controlled nausea. Either way, she's having a sympathetic dump every few minutes that's causing the increase in vital signs. Putting a patient on 15L who has good color and no complaints of shortness of breath might not be all that good of an idea. Why? You're only going to increase the amount of anxiety, which isn't going to help things any. 2L or even 0L by nasal cannula wouldn't help things much but may result in the patient thinking things are OK, and with a little coaching, guided imagery (you're in a nice comfy, warm and safe place... let's go there in your mind...), and a nice & smooth ride might just keep things from getting too out of hand.


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## Handsome Robb (Apr 21, 2013)

Sounds like anxiety...

Pot on board, new meds, post op, no other associated symptoms, hypertensive and tachycardia intermittently.

Take a peek at the side effects of marijuana.


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## Melclin (Apr 25, 2013)

An arrhythmia isn't out of the question. But I doubt it.

PE? Very unlikely. Tachycardia is certainly a common finding in people with PE. But in isolation and with it coming and going? Probably not. She is anti coagulated, has only one risk factor and no PE symptoms. 

The first thing I thought of was that the pot may not have been pot (or pot alone).
My understanding is that synthetic weed (or really rubbish weed sprayed with synthetics) often has a lot of weird sympathomimetic effects, some of which have a certain amount of danger associated with them. More danger than normal weed anyway. I don't think its a mystery where the uncomfortable sensations are coming from. 

Even if it was normal weed, it could still produce this type of thing. Tramadol can also produce some "weird feelings". Have a read up on weed, synthetic weed and tramadol and it might be a bit clearer. Better yet, call you brother's friends cousin, get sorted, dr shop some tramadol, order up big at Micky D's and conduct yourself some science. 

I agree that she didn't need O2, but I suppose your hands may have been tied by local protocols or something. I've never understood this idea that applying a mask "makes people fell better". I've never once had a pt that didn't hate having a mask on. Other than being uncomfortable, I've only ever seen it increase their anxiety or have no effect, never improve anxiety. They seem to think, oh am I that sick? All the family and friends see the mask on their face and they all think of dying people on TV. Not to mention the fact that I can't hear a word people are saying with a mask on. I don't know how you guys do it with your constant 15L for everyone stuff.


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