# 68 yo F For a Fall



## ghost02 (Sep 18, 2014)

Respond Code 3 to residence for a Fall

Arrive to find Fire on scene. There are multiple steps into the residence, and the Patient is sitting on the bed in a back room with a NRB @ 15lpm. The patient has a bloody nose, but airway is patent. Breathing is ~22 per min. Pulse is rapid and weak. Patient is Cool, pale, but dry.

Fire states that the patient fell in the bathroom and then woke up 3 minutes later according to family. Fire also states that the blood pressure is high.

Alright guys, have at it. Anything questions I can answer, I will.


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## teedubbyaw (Sep 18, 2014)

4 lead and vitals are first priority.


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## ghost02 (Sep 18, 2014)

Vitals of...

BP: 154/100
PR: 100
RR: 22
SP02: 100% on NRB 15lpm

4 Lead comes back abnormal (Sorry, Don't have particulars on that, but it was not NSR.)


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## STXmedic (Sep 18, 2014)

Along with history and meds. LOC?


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## STXmedic (Sep 18, 2014)

ghost02 said:


> 4 Lead comes back abnormal (Sorry, Don't have particulars on that, but it was not NSR.)


Kinda important.... I'm guessing no 12 lead either?


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## ghost02 (Sep 18, 2014)

Yes LOC.
History of an unknown cardiac issue. Unknown Meds (Family was not in the know, and the patient was not responding)

12 lead was difficult to attain, but spat out Acute MI, I did not catch what kind though, (I'm a basic)

Pt begins to breath more slowly and more deeply after 12 lead attempt, and is now diaphoretic as well.


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## STXmedic (Sep 18, 2014)

Is there any more information we don't have?

Wait, was it unreadable due to movement like you said before editing, or did it actually say AMI?


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## ghost02 (Sep 18, 2014)

Yes, now to the more interesting part, at least to me.

During movement out of the residence via stair chair, the patient becomes pulseless and apneic.

CPR has been initiated, along with BLS airway.
Rhythm is PEA.


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## DesertMedic66 (Sep 18, 2014)

Saying a rhythm wasn't NSR or in this case sinus tachy isn't extremely helpful. It could easily be a BBB that caused the monitor to say acute MI.


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## STXmedic (Sep 18, 2014)

ghost02 said:


> Yes, now to the more interesting part, at least to me.
> 
> During movement out of the residence via stair chair, the patient becomes pulseless and apneic.
> 
> ...


So were you hoping for some kind of answer, or did you just want to tell us you had a patient that coded?


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## ghost02 (Sep 18, 2014)

I thought of that before I posted this, as the EKG is the important part of this whole scenario, but during the whole call the monitor was causing huge issues for us, the 12 lead did not read at all due to pt movement, we could not really get a good handle on what was happening.

What I am really looking for is the thought processes on what happens for a PEA, and when there are equipment issues. I am trying to piece together how an assessment for something like this would work. I admit, it is a crappy scenario in terms of others involvements, but I was looking for where your minds went, so I can try and apply them to myself. In retrospect, this was a bad scenario to do this on.


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## STXmedic (Sep 18, 2014)

What do you mean by "thought processes on what happens for a PEA"? Treatment? Causes? Que?


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## ghost02 (Sep 18, 2014)

Treatments mostly. Why certain drugs are used rather than others.


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## DesertMedic66 (Sep 18, 2014)

ghost02 said:


> Treatments mostly. Why certain drugs are used rather than others.


If you're going based off of AHA ACLS standards really the only drug that is given for PEA is Epi.


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## DesertMedic66 (Sep 18, 2014)

DesertEMT66 said:


> Saying a rhythm wasn't NSR or in this case sinus tachy isn't extremely helpful. It could easily be a BBB that caused the monitor to say acute MI.


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## teedubbyaw (Sep 18, 2014)

Sounds like she had an allergic reaction to a potato.


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## tpchristifulli (Sep 18, 2014)

Easy... Sarcoidosis


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## ViolynEMT (Sep 18, 2014)

ICP? Was there any jvd. Maybe she hit her head when she fell.


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## teedubbyaw (Sep 18, 2014)

ViolynEMT said:


> ICP? Was there any jvd. Maybe she hit her head when she fell.



What does JVD have to do with increased ICP?


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## ViolynEMT (Sep 18, 2014)

Doesn't. Got Cushings and Beck's triads mixed up. Still learning.


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