Chest Pain Case

bakertaylor28 said:
Yeah. Its a syndrome that results in ***some people*** using a defibrillator without having first read the manual. Not naming any names, but we all KNOW who I'm talking about.
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Do we? I made a comment about reading the manual... Are you talking about me?


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VentMonkey said:
Fair enough, but may I ask what your reasoning for aggressive IV fluids continues to be? I understand them being heavily preload dependent, bur by no means will this be a life-saving measure...

http://ether.stanford.edu/library/cardiac_anesthesia/Cardiology/Acute Cardiac Tamponade.pdf
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Well no, never said it's a definitive treatment but aside from an emergent pericardiocentesis (whether pre-hospital or in the hospital) it's one of the only few things y'all can do in the field. I'm not talking about flooding them with 2L but give them a 500ml bolus or something to see if hemodynamics improve a bit while they're waiting for definitive treatment. Not much good data either way on it and yea, I'm sure you'll read all sorts of opinions in the literature about it but practically I'd say that's how a lot of us approach it while we're waiting for either the tap or a surgical window.
 
gotshirtz001 said:
Do we? I made a comment about reading the manual... Are you talking about me?


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You and me both.




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Sometimes the best thing to do is to do nothing. People can remain in Mobitz II for long periods without being unstable. The dude needs a pericardiocentesis so the best thing to do is get him to the ER quickly and safely.
 
FLdoc2011 said:
Based on the description he's in tamponade or about to be and about the only you can do at this point is give fluid. So open up the fluid and get him in. Don't limit the fluids thinking it's just going to go into the pericardial space, he's pre-load dependent at this point.
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I think given that you had initially mentioned this, I was under the impression that you were willing to dump fluids in liberally without regard.
FLdoc2011 said:
Well no, never said it's a definitive treatment but aside from an emergent pericardiocentesis (whether pre-hospital or in the hospital) it's one of the only few things y'all can do in the field. I'm not talking about flooding them with 2L but give them a 500ml bolus or something to see if hemodynamics improve a bit
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But ultimately it would appear that our thought processes are along the same vein. I jwas simply curious, cheers:).
 
VentMonkey said:
I think given that you had initially mentioned this, I was under the impression that you were willing to dump fluids in liberally without regard.

But ultimately it would appear that our thought processes are along the same vein. I jwas simply curious, cheers:).
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No problem. I was mainly trying to to bring it back to some sort of practical discussion given some of the earlier posts, lol. Don't always have something to add but this happened to be in my field and deal with it not infrequently.
 
gotshirtz001 said:
Do we? I made a comment about reading the manual... Are you talking about me?


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You really have to ask? I was referencing members of the male sex in general- whom rarely read an instruction manual and then WONDER how it is that they end up on an episode of home improvement opposite Al. (a dated reference I know- but for lack of a better one.)
 
FLdoc2011 said:
No problem. I was mainly trying to to bring it back to some sort of practical discussion given some of the earlier posts, lol. Don't always have something to add but this happened to be in my field and deal with it not infrequently.
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Interesting... Maybe you should consider proctology as a secondary sub? You seem to have the personality for it. just a thought....lol ;-)
 
Chase said:
I wasn't even born yet :eek:
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Yeah and whats more is that the older materials didn't even THINK about going into the territory of subjective decision making- i.e. where they present an technically O.K. answer and then a "regarded to be correct" answer on the tests, because in the 70's and 80's a medic relied on medical direction for EVERYTHING. We started migrating to our present form of things in the late 80s and early 90s. Back in the 70s Paramedic training had more of the emphasis of HOW to do things Vs. Subjective Reasoning of WHEN to do things. Hence, there was a medical order for every time you pushed a drug, defibrillation actually required that the ecg be transmitted first, ect. in the Early 80s the current notion of things were being developed as cohesive training methods, and were beginning to be implemented in the field with resistance from some (whom probably saw the paramedic as mounting a status challenge to the M.D. at the time given that the separation of the two were in a bit of a flux at the time) starting around 1985 or so. The early 90s saw a steep learning curve for out of hospital treatment providers- as the transition to our current state of things was full throttle at that point.
 
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MonkeyArrow said:
Source?
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Any retelling of paramedic history. The development of telemetry for space missions is what led to telemetry transmission to allow defibrillation in the field by paramedics.

That's actual and factual. I'll be happy to pull up some sources for you later on, but that's all truth
 
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