Had a Code 3 80 YO M Pt. yesterday

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firemedic0227

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Bare in mind I am only a "Student" doing a ride a long while doing team leads with a fire/medic service in my area. Yesterday we were Dispatched to a Male Pt that is unconscious but breathing. We get there and the Engine Company with 2 medics on board are already there. They have no O2 therapy going on this guy, they did a glucose stick revealing 87mmhg. This patient has a hx of Heart Related Problems he's been unconscious for about 20 minutes at this point. We get some 02 therapy get a BP of 90 by Palp respirations at 16 and get him on the Monitor which reveals a HR over 100 and irregular.

So we load him up and get him in the back of the squad get an IV established get him hooked up to a 12 lead which reveals Atrial Fibrillation. We go code 3 to the nearest Medical Center. We arrive in about 4 minutes to the ED and he is still semi-unconscious not alert at all but withdrawing to pain. Should we have done the ACLS protocol for Atrial Fibrillation? We never found out what was actually wrong with this older gentleman. Anyone know if his uncounsiousness is caused by the possible Atrial Fibrillation or maybe another cause. He had no history of Diabetes either.
 
I'm going to go ahead and say that the a-fib wasn't the cause, granted it was new onset, but I'm still not thinking the a-fib was the cause. I wouldn't have treated the a-fib from what you've said. What was the actual rate?

What other physical findings were there? LS? What other medical history did he have? Medications?

Did you consider a UTI?
 
First, BGL isn't measured in mmHg. :unsure:

What made you want to do "O2 therapy"? What sort of 'heart related problems' did he have a history of? What medications was he on? What made you think you should have treated the a-fib?





Without knowing the possible onset of the a-fib, I wouldn't touch it, especially since no other signs are indicative of it. High HR (do beats match?), passable BP (even at 90mmHg). Only thing off is the altered level of consciousness. Unless they were seen at the doctor yesterday, given a 12-lead showing no a-fib, and they provide you with that 12-lead, I'd be very very very hesitant at touching it.
 
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arharris83 said:
Bare in mind I am only a "Student" doing a ride a long while doing team leads with a fire/medic service in my area. Yesterday we were Dispatched to a Male Pt that is unconscious but breathing.
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It's always a crying shame when people are butt breathing. I really want to overcome that whenever possible.

We get there and the Engine Company with 2 medics on board are already there. They have no O2 therapy going on this guy, they did a glucose stick revealing 87mmhg. This patient has a hx of Heart Related Problems he's been unconscious for about 20 minutes at this point. We get some 02 therapy get a BP of 90 by Palp respirations at 16 and get him on the Monitor which reveals a HR over 100 and irregular.
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What was the history? What happened here? Did the people on the scene just stumble on him, or was there some kind of story about how he was doing before he lost consciousness?

Glucose sticks are typically in milligrams per deciliter (mg/dL). Blood pressures are in mmHg.

How were the o2 sats before and after you put him on oxygen? How was his airway? Did he require any airway adjuncts, or just positioning?

What was his pulse rate? Did it differ from the rate on the monitor? Were there non-perfusing beats involved? How far over 100 was the rate? At what point would you be worried about a person's tachycardia, and in what conditions?

So we load him up and get him in the back of the squad get an IV established get him hooked up to a 12 lead which reveals Atrial Fibrillation. We go code 3 to the nearest Medical Center. We arrive in about 4 minutes to the ED and he is still semi-unconscious not alert at all but withdrawing to pain. Should we have done the ACLS protocol for Atrial Fibrillation? We never found out what was actually wrong with this older gentleman. Anyone know if his uncounsiousness is caused by the possible Atrial Fibrillation or maybe another cause. He had no history of Diabetes either.
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What ACLS protocol for Afib? The tachycardia protocol? Again, think about what his rate was, and whether it was the problem in and of itself or whether it was a symptom of something else.

You maybe could have found out more if you spent a little more time looking for clues, or if you included them in your story-telling for us.

The list of what his problem could have been is long and varied. Old people who live in afib often have a multitude of other problems. Afib is almost always a symptom of a problem, not a stand-alone issue.

Ever hear of the coma cause mneumonic AEIOU-TIPS? Use it when you come on someone who is unconscious. Don't focus in on the first thing you can drum up, rule in or out the other possible causes, and you'll be way further down the path of helping the hospital figure out what the problem is.
 
I just gotta few things, why treat the afib just because it is over 100 BPM? I don't start thinking about treatment until we are up around the 150bpm range and even then I is be all like, hey why the Rapid afib? Is this something I can treat without Cardiazem?

Second, and I am going wayyyyyyyyyy out on a limb here with a stab in the dark guess and I am going to stay this dude had a stroke.

BS is good, you say 12-Lead good, is in Afib. Granted it could be anything including UTI, electrolyte defen. But, I felt like guessing on this one. Call the ER and ask what they found, did they send the patient off to CT right away?
 
fast65 said:
I'm going to go ahead and say that the a-fib wasn't the cause, granted it was new onset, but I'm still not thinking the a-fib was the cause. I wouldn't have treated the a-fib from what you've said. What was the actual rate?

What other physical findings were there? LS? What other medical history did he have? Medications?

Did you consider a UTI?
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What in his description tells you the afib is new onset? Is it the RVR?

Also, as an aside, i've been taught that all elderly/NH patients have UTIs until proven otherwise...which happens at the hospital, so they all have UTIs...
 
jjesusfreak01 said:
What in his description tells you the afib is new onset? Is it the RVR?

Also, as an aside, i've been taught that all elderly/NH patients have UTIs until proven otherwise...which happens at the hospital, so they all have UTIs...
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Elderly/NH? I haven't heard of this abbreviation before
 
jjesusfreak01 said:
What in his description tells you the afib is new onset? Is it the RVR?

Also, as an aside, i've been taught that all elderly/NH patients have UTIs until proven otherwise...which happens at the hospital, so they all have UTIs...
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Huh, I could of sworn that I read it was new onset, guess not lol

Oh Fish, NH means nursing home


Sent from my iPhone using Tapatalk
 
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fast65 said:
Huh, I could of sworn that I read it was new onset, guess not lol

Oh Fish, NH means nursing home


Sent from my iPhone using Tapatalk
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Oh, Duh! Brain Fart
 
Stroke or urosepis seems likely.

Temp?
How far over 100 was the afib?
Gross neurological deficits?

Cardiac complaints are not generally a cause of altered LOC, if they are, it's generally dire.
 
usalsfyre said:
Stroke or urosepis seems likely.

Temp?
How far over 100 was the afib?
Gross neurological deficits?

Cardiac complaints are not generally a cause of altered LOC, if they are, it's generally dire.
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I keep trying to decifer your username.

I got US-ALS_but what is the fyre? Supposed to be Fire?
 
Yeah, from back in my knuckle dragging hose monkey days. "Fire" was taken on whatever I was trying to register for, fyre was not lol.
 
Thats what I thought, hey I see your old employer is offering a 5k sign on bonus! think they miss u
 
Nahh, fairly sure they don't lol. If your willing to call BS on management, no matter how politely, they won't miss you :D.
 
usalsfyre said:
Yeah, from back in my knuckle dragging hose monkey days. "Fire" was taken on whatever I was trying to register for, fyre was not lol.
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I think I'm the only person in the world who went to fire school to get a medic job, lol. Hubby had a good laugh at me, 16 years into a productive career, going to fire class with a bunch of kids born when I was starting in EMS.
 
I get the feeling we're just talking to ourselves on this thread.
 
abckidsmom said:
I think I'm the only person in the world who went to fire school to get a medic job, lol. Hubby had a good laugh at me, 16 years into a productive career, going to fire class with a bunch of kids born when I was starting in EMS.
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Where you workin?
 
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