Interesting Cardiac call

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SoCal

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Just thought I'd share a call I ran recently.

Got a Code 3 ambulance only call at 1300 to a Clinic for a heart problem. Onscene found a 80 y/o female lying on table. pt. c/o chest pain rated at 2/10 that began at approx 0530 am and awoke her from sleep. pt. awoke and started to do some house chores when she got dizzy/ lightheaded along with the chest discomfort. clinic dr. has administered .4mg ntg that took her pain to 0/10, however still lightheaded and dizzy. asa withheld at clinic due to pt. on coumadin. 12-lead was taken with an underlying a-fib which is normal for the pt and uniform pvcs. clinic has a 22 ga. iv established pta. clinic has no o2 on her, spo2 96% RA.

H- A-fib, pacemaker ( showing no pacer spikes on clinic EKG, our EKG or any 12 lead taken), htn
A- None
M- Long list including coumadin.

while assessing pt, noticed the monitor switch into all wide complex, uniform PVCs (run of slow V-tach at a rate of 70-80, otherwise accelerated idioventricular rythm), pt. PVCs were perfusing, no recurrence of chest pain however dizziness and "ill" feeling increased. A-fib was still underlying rhythm.

How would you treat? I will post up what I did later.
 
O2; probably 4 l//m via N/C. depends on your protocols from there. Some can do Lidocaine for V-tach (multiple PVC's) other places can do 150mg Amiodarone.
You didn't give a B/P but I would give a bolus no matter what the BP is; some people get dehydrated and it can screw with their heart rhythm even if the BP is ok.
 
SoCal said:
H- A-fib, pacemaker ( showing no pacer spikes on clinic EKG, our EKG or any 12 lead taken), htn
A- None
M- Long list including coumadin.
Click to expand...

The rest of the medications and history would be important for this.
 
All uniform PVC's at a resonable rate with hx of pacemaker, are you sure it wasn't a paced rhythm?
 
^^
this call was a month or so ago, I can't recall all H,A,M. Just ran too many calls since then. Sorry.

B/P was 190/100, repeat B/P were all around 170/90 ish...

Like I said, pt. did have a pacemaker, however she had no pacer spikes on any of the 3 cardiac monitors she was placed on (clinics, EMS and hospitals) and she did have an underlying rhythm, an a-fib underlying with no pacer spikes mixed in on either rhythm.
 
Ok just a wild stab in the dark here, but as none of the readings showed a spike,
could her pacemaker have run out of battery power and for some weird reason the heart was beating of it's own accord?
As I said, I'm not sure if that is at all possible, but thought I'd throw the question in anyway.

Cheers Enjoynz
 
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