Discussion in 'EMS Lounge' started by titmouse, Jul 31, 2014.
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.
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.
Call dispatched as ‘chest pain’, AOS to find a 48 y.o. homeless foreign national male sitting on a curb, w/ fire correcting the chief to ‘anxiety’, stating that the pt denied hx/meds/allergies. Pt insists on SOB, fire sends him BLS w/ no strip/scene vitals. Per pt, feels ‘pressure on chest, radiating to back’ + SOB and it’s a recurring episode. Pt presents tachypneac @ 30 with chest discomfort, carries with him a prescription from an MD in Mexico for ASA, Digoxin and some other chicken scratch.
8 min later in the ER:
Charge nurse: ‘A c/c of anxiety ? So now they diagnose too, huh ? I want the fire sequence & engine number, and get 12 leads on him stat !’
The waveform was nearly flat with maybe 3mm R’s, 140/101, 112, 31.
Fever of 103.7 at a SNF 1 mile away from the ED. No good IV sites and she has a A-V fistula and a medi-port. Easy transport for me.
Patients lactate was 8 and serum glucose >700.
That might be the sickest patient ive ever encountered that still had a pulse.
Cardiac arrest 50 feet from a working barn fire. Volly FD showed up to put wet stuff on the hot stuff and found the patient unresponsive near the barn. Reportedly he was last seen just prior to FD arrival when his neighbor told him his barn was on fire.
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)
What kind of thrombolysis was provided in the ED? And was this administered intra-arrest?
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