I Wish I could pass my test so I could join in on this.......
I had a clinic "diagnosed" Takotsubo Cardiomyopathy. It just so happens that's one of my personal favorite conditions. The problem is, they theorized that is developed over 20 minutes after the patient received some bad news.Local urgent care, theyre throwing around words like "severe bradycardia", "almost had to intubate", "pacemaker".
Arrive to find a 61 year old male sitting upright and alert c/o "a little dizziness".
HR 54, BP 170/90, beta blockers on the med list.
Patients lactate was 8 and serum glucose >700.Same shift, new day.
Chest pain for two days. Second degree type 2 at a rate of 40 with an underlying Inferior/posterior STEMI a bp of 70 systolic. Critical monitor failure during pacing attempt.
Rhythm converted to 3rd degree post pacing attempt. She went to cath lab but not looking good.
What kind of thrombolysis was provided in the ED? And was this administered intra-arrest?Diabetic emergency at a wedding. Usually an ILS/BLS ambulance would be dispatched for this but seeing that there were no busses available dispatch requested that we (ALS/Response Vehicle) go and stabilise the patient so long.
O/A: 64yo male sitting in a chair, alert and oriented. Pt states that he thinks his "sugar" is low because he feels a bit "slow".
While my crew mate checked his BGL I attached our monitoring devices.
Initial vital signs:
BGL: 7,8 mmol/L
SpO2: 86% on RA
RR: 20 bpm
BP: Unrecordable with NIBP, manual BP reveals SBP of 40 mm/Hg
A quick 12 lead revealed a massive Inferior wall MI with RV involvement. With the closest hospital being 5 minutes away we made the decision to load this patient ASAP and proceed to the hospital (luckily an ambulance arrived while we were assessing the pt) .
After we loaded the pt onto our gurney he stated that that he is really starting to feel unwell, our Lifepak also revealed that his HR increased to 200 beats per minute (average over approximately 30 seconds). Not long after this the patient had classic peri-arrest "seizures" and subsequently went into VFib.
After approximately 5 minutes ROSC was obtained but as we stopped at the hospital he went into cardiac arrest again.
Doctor initiated thrombolytic therapy upon our arrival at the ER but unfortunately the patient was declared deceased after 30 minutes of CPR (ROSC was obtained again during this time but the pt quickly deteriorated again)