WuLabsWuTecH
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So my partner and I were on special duty at the state park and were in line to get some coffee at the concessions stand. We hear a commotion in front of us and look up to see a lady that passed out. Our ATV/Cart thingy was about 20 feet away so I go get it and my partner walks up the 10 feet to her.
She arose to verbal yelling and was grunting but breathing ok, so we move to vitals. This is the part that confuses me. My partner does the glucose check and I do everything else. I start with BP which was very, very hard to get on her arm so I check her pulse. It was initially not present at the radial. I check the brachial and it was thready and checking the radial again it was there but very faint. (At this point she has come to and has sat up and is conversing with us). I palp a BP and get 94/P. I double check it and it's 96/P the second time so I'm fairly certain it wasn't user error.
Respirations were about 16, and her pulse was 62, thready, but regular.
A medic walks up and starts a line and 250 mL of fluid (the entire bag) goes into her in in about 5 minutes. It was a hot day and she had nothing to drink since 8am (it was now 3PM).
At the extraction point, we transfer to the transport ambulance who got a BP of 134/82, and a HR of 134.
This came back on CQI. The CQI officer says that he is just as unsure of whether I was right or not, but both of us sat down and we are having a bit of trouble explaining this one physiologically. Here's my thoughts, but they obviously do not match up with the vitals given as above.
The lady obviously passed out because her body wasn't able to perfuse her brain enough. Her body probably clamped down her periphery in order to shunt blood to her brain (explains the thready/absent distal pulses). Failing that, she fell to the ground. There's obviously no way to measure contractility (inotropy) in the field, but I would have guessed that it would increase as would the heart rate (chronotropy). So how do I explain the low BP and the low pulse? I would expect the BP to be low if we are saying hypotension was the cause of her issues, but the HR should have been high to compensate right?
The only explanation I can give to this is that we got there so fast (within 10 seconds) that her body didn't have time to compensate yet. By the time we got her to the extraction point (10 minutes later) her body was compensating and her BP came up as well as her HR. I sincerely doubt 250 mL of fluid would have done that much, but I guess it's possible. The only flaw with my theory is that her body should have begun compensating hours ago before she fell and only when the compensation quit working did she collapse so I still would have felt an elevated HR.
Any ideas anyone? She was a healthy, young woman (< 45), affluent, who had no medical history, was not taking any meds, and the only bit of interesting PMH was that she is allergic to penicillins. Otherwise her history was completely unremarkable.
So... Who wants to tackle this Physiology Case of the Week!?
She arose to verbal yelling and was grunting but breathing ok, so we move to vitals. This is the part that confuses me. My partner does the glucose check and I do everything else. I start with BP which was very, very hard to get on her arm so I check her pulse. It was initially not present at the radial. I check the brachial and it was thready and checking the radial again it was there but very faint. (At this point she has come to and has sat up and is conversing with us). I palp a BP and get 94/P. I double check it and it's 96/P the second time so I'm fairly certain it wasn't user error.
Respirations were about 16, and her pulse was 62, thready, but regular.
A medic walks up and starts a line and 250 mL of fluid (the entire bag) goes into her in in about 5 minutes. It was a hot day and she had nothing to drink since 8am (it was now 3PM).
At the extraction point, we transfer to the transport ambulance who got a BP of 134/82, and a HR of 134.
This came back on CQI. The CQI officer says that he is just as unsure of whether I was right or not, but both of us sat down and we are having a bit of trouble explaining this one physiologically. Here's my thoughts, but they obviously do not match up with the vitals given as above.
The lady obviously passed out because her body wasn't able to perfuse her brain enough. Her body probably clamped down her periphery in order to shunt blood to her brain (explains the thready/absent distal pulses). Failing that, she fell to the ground. There's obviously no way to measure contractility (inotropy) in the field, but I would have guessed that it would increase as would the heart rate (chronotropy). So how do I explain the low BP and the low pulse? I would expect the BP to be low if we are saying hypotension was the cause of her issues, but the HR should have been high to compensate right?
The only explanation I can give to this is that we got there so fast (within 10 seconds) that her body didn't have time to compensate yet. By the time we got her to the extraction point (10 minutes later) her body was compensating and her BP came up as well as her HR. I sincerely doubt 250 mL of fluid would have done that much, but I guess it's possible. The only flaw with my theory is that her body should have begun compensating hours ago before she fell and only when the compensation quit working did she collapse so I still would have felt an elevated HR.
Any ideas anyone? She was a healthy, young woman (< 45), affluent, who had no medical history, was not taking any meds, and the only bit of interesting PMH was that she is allergic to penicillins. Otherwise her history was completely unremarkable.
So... Who wants to tackle this Physiology Case of the Week!?
