Something Weird

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rockwood

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I'm a new emt... The other night my unit was called on a car wreck. No one was seriously injured and we got out patient into the ambulance without any trouble, the pt's vitals were fine 130\80 and a strong pulse around 80 or 90, and the patient was talking to us and responding to out questions and the pupils were fine, and then we re-took vitals and found that the patient's bp had dropped to 70\50 and at that same time the monitor showed us that the patient's pulse had dropped to around 60 and the patient when unresponsive after a few seconds, but after a sternal rub the patient came back and everything went back to normal. We were all weirded out by this and didn't really know what happened. It seemed like the patient passed out for a second.

Does anyone know what could cause this?
 
Could have been a syncopal episode caused by a vasovagal stimulation of some kind.
 
HJAver you extricated him yet or waiting for our feedback?

;)
The sternal rub didn't affect the VS, that was coincidental or in errror.
Manual or machine VS's?
 
Could have been a syncopal episode caused by a vasovagal stimulation of some kind.
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That's what it sounds like. To the OP, this is one of the reasons we don't do rectal exams on trauma patients in the field. ;)
 
well the sternal rub must have woken the paitent back up, i was just wondering what would cause someone to faint like that
 
rockwood said:
well the sternal rub must have woken the paitent back up, i was just wondering what would cause someone to faint like that
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Actually more than likely, the sternal rub had nothing to do with waking him back up. Once people vagal down to the point of syncope, generally the stimulus goes away and the patient rapidly comes back to consciousness.
 
Or the sternal rub did wake him up, but only because he was already recovering.

Sometimes vitals are like cell phone snapshots, they can be taken at moments flattering or terrifying but a repeat will clear it up.
 
Also, don't do sternal rubs. Ever. Unless you like being sued.

Pinching the trapezius, or a properly applied ammonia inhalant works wonders. Notice I said PROPERLY.
 
Fox800 said:
Also, don't do sternal rubs. Ever. Unless you like being sued.

Pinching the trapezius, or a properly applied ammonia inhalant works wonders. Notice I said PROPERLY.
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I have been an EMT a little over a year...what is wrong with sternal rubs? That is what they teach in class (and yes, I know what they teach differs from how things are done in the field), but how can you get sued over a sternal rub?
 
mar7967 said:
I have been an EMT a little over a year...what is wrong with sternal rubs? That is what they teach in class (and yes, I know what they teach differs from how things are done in the field), but how can you get sued over a sternal rub?
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Bruised sternum, broken ribs, etc. It's just not a good idea. There are much better alternatives.
 
Fox800 said:
Bruised sternum, broken ribs, etc. It's just not a good idea. There are much better alternatives.
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If you break a rib doing one, you're probably either doing it wrong or it's not your fault due to a bone problem.


It's better to do something else that actually has an affect on the cns rather than the pns such as a trap squeeze.
 
it was once suggested to me to take a pen, put it perpendicular to the pts fingers, between the base of two of the fingers, and push the knuckles just above the pen together around the pen. try it on yourself. if it doesn't wake up the pt they most likely are truly out.

oh, and anybody ever uses an ammonia inhalant on me better have the intubation kit ready....you can't properly apply an ammonia inhalant to an unresponsive pt unless you know for sure and 100% certain they don't have any reactions to it...and how do you know that unless you ask them? (i have asthma, btw, and ammonia inhalants are one of my bigger triggers - i accidentally broke one doing a rig check and had to use one of the neb setups -- and that was 2 ft away from my face AND i threw it out of the truck right away AND there was a strong breeze blowing away from the truck)
 
Linuss said:
If you break a rib doing one, you're probably either doing it wrong or it's not your fault due to a bone problem.


It's better to do something else that actually has an affect on the cns rather than the pns such as a trap squeeze.
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quoted for truth
 
PrincessAnika said:
it was once suggested to me to take a pen, put it perpendicular to the pts fingers, between the base of two of the fingers, and push the knuckles just above the pen together around the pen. try it on yourself. if it doesn't wake up the pt they most likely are truly out.
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please do not brutalize your patients. use a trap squeeze.
 
Linuss said:
If you break a rib doing one, you're probably either doing it wrong or it's not your fault due to a bone problem.


It's better to do something else that actually has an affect on the cns rather than the pns such as a trap squeeze.
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Have fun explaining the sternal bruising. Pen trick, trap pinch, pen on knuckles > sternal rub.

The ol' OPA or NPA is a great tool for unresponsiveness, too. It also assists in airway patency.
 
Fox800 said:
Have fun explaining the sternal bruising. Pen trick, trap pinch, pen on knuckles > sternal rub.

The ol' OPA or NPA is a great tool for unresponsiveness, too. It also assists in airway patency.
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except when it fills with vomit!


no one mentioned corneal reflex. Great way to assess acceptance of an OPA too.
 
8jimi8 said:
except when it fills with vomit!


no one mentioned corneal reflex. Great way to assess acceptance of an OPA too.
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Then you probably should have pulled it at the first sign of your patient not tolerating it.

Might I suggest an NPA w/lidocaine surgical jelly before an OPA, if you think your pt. might be "lightly" unconscious or faking, as opposed to jumping straight to an OPA?

It's uncanny how well it works.
 
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