Appendicitis.... Cardiac issue

Chris EMT J

Forum Lieutenant
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So this is a wild one a few sma changes for patient privacy.

14 y/o female cc of ABD pain

ABC: airway clear and protecting, breathing effort normal with no difficulty, circulation okay on appearance and mental status= A&O x 4

Sample:
ABD pain, specifically RLQ, sharp, w/ hip radiation
Allergic to penicillin based medication

Daily aspirin (doctor recommended)

History of unknown arrhythmias (parents didn't remember the name)

Last oral intake was a sandwich

Events leading was just reading a book

Original vitals:
HR 115 (sinus) BP 168/91 O2 92% RR 12 BGL 140 and temp 98.7f

ECG preformed due to cardiac history which was normal sinus tachycardia

Mc Burney point positive

Transport started for possible appendicitis heading to a children's hospital less then 10min

Breathing sounded clear so started on 3lpm NC

Then medic told me to pull over and stop moving then I heard him use his side radio "patient CPR in progress" and he yelled drive so I started driving faster and I heard the lotus CPR machine and we arrived then the medic went in I parked and went in and medic was giving report while the room was full of people. We left shortly after and CPR was still in progress. Any ideas?
 

NomadicMedic

EMS Educator
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Yeah, abdominal pain for a female of child bearing age, leading to arrest? Ectopic.
 
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Chris EMT J

Chris EMT J

Forum Lieutenant
124
10
18
Ectopic is something I didn't think about but now that I am that sounds like a good possibility.
 

Tigger

Dodges Pucks
Community Leader
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Ectopic pregnancy at the top of the list sure, but this could be literally anything. Go talk to your CES or QA people, they can get you some actual followup. This is just a guessing game.
 

E tank

Caution: Paralyzing Agent
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...this could be literally anything. Go talk to your CES or QA people, they can get you some actual followup. This is just a guessing game.
Agreed...what did the paramedics history and physical reveal? LMP? GYN hx? Lots there that will raise or lower index of suspicion and should be a routine consideration on these kinds of calls....would be very unusual for a ruptured to present with a full arrest. If the patient didn't appear ghostly blanched white if Caucasian or just grey with white mucous membranes of any other race, odds are low that was a hypovolemic arrest.
 
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Chris EMT J

Chris EMT J

Forum Lieutenant
124
10
18
I did finally figure out how I can get the update so the update is patient had a ruptured aneurysm from a birth defect on the hepatic artery.
 

Aprz

Non flying critical care flight attendant
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I did finally figure out how I can get the update so the update is patient had a ruptured aneurysm from a birth defect on the hepatic artery.
Probably the most important update... did she survive????
 

silver

Forum Asst. Chief
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The daily ASA in a pediatric patient should get you thinking that this person has a serious chronic illness (eg. hx congenital heart disease with some conduit/shunt, prior stroke, stent, vasculitis/Kawasaki disease).
 
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Chris EMT J

Chris EMT J

Forum Lieutenant
124
10
18
Probably the most important update... did she survive????
Yes they got Return of spontaneous circulation and this case was a little bit ago so I should be allowed to say that after about a 2wks and a half I was able to do a IFT from hospital back home
 
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Chris EMT J

Chris EMT J

Forum Lieutenant
124
10
18
The daily ASA in a pediatric patient should get you thinking that this person has a serious chronic illness (eg. hx congenital heart disease with some conduit/shunt, prior stroke, stent, vasculitis/Kawasaki disease).
The history of daily aspirin+ arrythmias unknown we suspected a congenital cardiac disease
 

Summit

Critical Crazy
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Interesting. First time reading the thread. Eyebrows went high on that daily ASA. Glad she made it.
 

Akulahawk

EMT-P/ED RN
Community Leader
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With a complaint of RLQ pn? Why?

We were trying to guess what the pmx was not the differential for the presentation
RLQ pain / positive McBurney’s point definitely speaks to an appy. Asking about meds got the ASA as a daily med. That is not usual so… good on the crew to keep their suspicion elevated. The rapidity of losing pulses usually means something popped. Proximity to the hospital and fast recognition of the new problem probably led to a reasonably good outcome.
 
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