# Blue lips



## jefftherealmccoy (Sep 5, 2013)

Called for a 33/M sick person.  pt laying on couch on arrival.  C/o cramping and R foot swelling. no pain, N/V, SOB.  Nothing.  Hx- pt has 3 chambered heart with pacemaker.  EKG shows an irregularly paced rhythm.  bp 96 systolic.  pt says he nomally runs low.  pt goes to put a shirt on to get on the gurney and his lips start to turn a little blue.  o2 sats 88%.  4L o2 brings sats up.  lips change back.  no complaints into the ER.  but while i'm giving report he keeps having fits of SVT around 150.  we transfer him to the hospital bed and as i'm giving report he turns more and more blue.  

we left him in ER's care and come back later to find out he's been admitted.  ER got a BP of 50 systolic and he's stuck in a fib/flutter. 

any guesses?  and if you get it, any way we could have seen this coming while on scene?


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## VFlutter (Sep 5, 2013)

jefftherealmccoy said:


> Called for a 33/M sick person.  pt laying on couch on arrival.  C/o cramping and R foot swelling. no pain, N/V, SOB.  Nothing.  Hx- pt has 3 chambered heart with pacemaker.  EKG shows an irregularly paced rhythm.  bp 96 systolic.  pt says he nomally runs low.  pt goes to put a shirt on to get on the gurney and his lips start to turn a little blue.  o2 sats 88%.  4L o2 brings sats up.  lips change back.  no complaints into the ER.  but while i'm giving report he keeps having fits of SVT around 150.  we transfer him to the hospital bed and as i'm giving report he turns more and more blue.
> 
> we left him in ER's care and come back later to find out he's been admitted.  ER got a BP of 50 systolic and he's stuck in a fib/flutter.
> 
> any guesses?  and if you get it, any way we could have seen this coming while on scene?



Are you saying this patient has only 3 heart chambers, a rare congenital abnormality, or that they have a 3 chamber pacemaker? I am assuming you mean 3 chamber heart but I just want to clarify. 

Do you know what chambers he has? 2A1V or 1A2V?

Either way, you can assume that this patients cardiopulmonary status is going to be very complicated. I would also assume they are normally slightly hypoxic due to significant shunt.


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## mycrofft (Sep 5, 2013)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1289113/






http://www.cdc.gov/ncbddd/heartdefects/hlhs.html


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## mycrofft (Sep 5, 2013)

Chase said:


> Are you saying this patient has only 3 heart chambers, a rare congenital abnormality, or that they have a 3 chamber pacemaker? I am assuming you mean 3 chamber heart but I just want to clarify.
> 
> Do you know what chambers he has? 2A1V or 1A2V?
> 
> Either way, you can assume that this patients cardiopulmonary status is going to be very complicated. I would also assume they are normally slightly hypoxic due to significant shunt.



Apparently it's going to be one (right) ventricle.


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## EMT B (Sep 6, 2013)

how does the heart work with only one ventricle? how does the electrical conduction system even work?


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## VFlutter (Sep 6, 2013)

EMT B said:


> how does the heart work with only one ventricle? how does the electrical conduction system even work?



Not very well...


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## mycrofft (Sep 6, 2013)

http://www.cdc.gov/ncbddd/heartdefects/hlhs.html

I can't find any references beyond those above (see earlier reply). My GUESS is the EKG would reflect an absence of the left myocrdium's repolarization etc. In other words, "???".


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## jefftherealmccoy (Sep 9, 2013)

Chase said:


> Are you saying this patient has only 3 heart chambers, a rare congenital abnormality, or that they have a 3 chamber pacemaker? I am assuming you mean 3 chamber heart but I just want to clarify.
> 
> Do you know what chambers he has? 2A1V or 1A2V?
> 
> Either way, you can assume that this patients cardiopulmonary status is going to be very complicated. I would also assume they are normally slightly hypoxic due to significant shunt.



I don't know what chambers he had, but i thought the same thing about the hypoxia, so i didn't think much of the blue lips.  the dude ended up having 2 PE's.  very bad. they stuck him in the ICU, haven't heard how he ended up doing. 

Any ideas how I could have diagnosed this better?


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## mycrofft (Sep 9, 2013)

No. It's a zebra egg (one step rarer than a zebra). And the practical difference in treatment at the prehospital level (or the inpatient level?)...:unsure:.


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## EMT B (Sep 10, 2013)

mycrofft said:


> http://www.cdc.gov/ncbddd/heartdefects/hlhs.html
> 
> I can't find any references beyond those above (see earlier reply). My GUESS is the EKG would reflect an absence of the left myocrdium's repolarization etc. In other words, "???".



Well the picture below shows that the LV is too small, but has a large mass of muscle around it. do you think it would show LVH due to this excess muscle?


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