Scenario

according to my protocols...give Atropine 0.5 and get ready to pace. Monitor that airway as it can go south real quick, I would go ahead with high flow O2, I would want another blood sugar.
 
The patient was given 0.5 mg atropine via IVP. HR increased to 78 Sinus Rhythm without ectopy. No change on the patients mental status or BP. What now? This call would've been an intern killer.
 
Rykielz said:
The patient was given 0.5 mg atropine via IVP. HR increased to 78 Sinus Rhythm without ectopy. No change on the patients mental status or BP. What now? This call would've been an intern killer.
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What was the patient's official diagnosis?
 
Rykielz said:
Second part of the scenario:

You begin transporting the patient. She's on 2 LPM O2 via NC and has an 18G NS lock established in her left hand. You contact the base hospital (stroke center and also the closest hospital) to give them a report. In the middle of the report you glance over and find the patient is now unconscious and unresponsive. You are now 15 min out code 3.

Vital signs:
GCS: 3
Rhythm: Sinus Bradycardia without ectopy
12-lead: Sinus Bradycardia. Otherwise normal.
HR: 39
BP: 69/43
RR: 14. Good tidal volume.
SpO2 on 2 LPM: 94%
Pupils: 6mm fixed and dilated
BS: Not reassessed. Original was 89.

Your medications are readily available. All other equipment will take time to set up. What do you do? Are there any additional assessments you would perform? What is your field diagnosis?
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I would get a manual BP since the auto NIBPs are notoriously inaccurate :cool:

15LPM NRB
250ml fluid bolus
Atropine 0.5mg
If Tx was longer I would consider pacing and/or dopamine.

Field Dx: I'm going for the generic "bleed". :rolleyes:
 
The patient was given 1L of fluid within 5 min. Her BP afterward was 63/49, which is actually a drop. I did confirm the BP the first time with a manual cuff. It was around 70/P. I relayed this to base and requested an order for Dopamine which was given. Pacing was not an option because the patients HR was now WNL.

After running the dopamine at 10mcg/kg/min for about 3 min, the patient went into SVT at 170. BP was repeated and was now 150/73. But most importantly the patient was now A&O x4 and now not delusional.

Official Dx is unknown. I didn't get a chance to follow up, but the doctor suspected an overdose as the cause.
 
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Because it is the easiest way to tell a CVA from Bell's Palsy. If you have a patient that is slurring their speech and/or has facial droop, but doesn't have arm drift or grip strength inequalities it is important to make sure you aren't dealing with a Bell's case. If the forehead still wrinkles it is more likely to be a CVA than Bell's, although the test isn't 100% accurate. However, it is more likely to err on the side of CVA, so it is still very useful.
 
Did you consider glucagon or calcium chloride when she bradyd down?

Meh Nevermind it's an ace inhibitor.
 
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Weird.

Sounds like some sort of OD to me, potentially polypharm with the brady/hypo then tachy/hyper. CNS stimulant vs. depressant anyone?

Definitely potentially a neurogenic problem as well but I'm not exactly sure what kind...

I'm not making any sense, I need to go to bed.
 
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