Septal infarct > Flash Pulmonary edema > Code

VFlutter

Flight Nurse
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Feel free to start a thread on ECMO management...

Back to the core concept here...should you really be aggressively treating hypotension pre-hospitally in a cardiogenic shock patient.
 

E tank

Caution: Paralyzing Agent
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Feel free to start a thread on ECMO management...

Back to the core concept here...should you really be aggressively treating hypotension pre-hospitally in a cardiogenic shock patient.
Due diligence toward a MAP of 65, yes, definitely, but I'd hesitate calling starting an inotrope aggressive if it's indicated. 5 minutes away? That comes into the decision making as does 45 minutes away. If the idea is avoiding an arrest, then yeah, get after it.
 

Underoath87

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Due diligence toward a MAP of 65, yes, definitely, but I'd hesitate calling starting an inotrope aggressive if it's indicated. 5 minutes away? That comes into the decision making as does 45 minutes away. If the idea is avoiding an arrest, then yeah, get after it.
In my EMS system we only have NS and an epi drip to treat hypotension (and nitro tablets and CPAP for pulmonary edema). How would you recommend managing the patient in the given scenario using just those tools? Granted, we're in a city with a PCI-capable hospital never more than 15 minutes away.
 

mrhunt

Forum Crew Member
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Well the pt arrested due to major conduction defects from the septal infarct and not from the hypotension. The fluid overload didn't help at all... And mind you I had a nearly 90 minute Transport time where he got steadily worse and worse... Watching his stemi tombstones grow and grow on recurring 12 leads.

Definitely an oh **** kinda pt....
 
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