Treatment question

[jamonica]

72 year old, very low BP, alert to loud verbal stimuli, but when he responds he makes jokes and then goes back to only responding to verbal stimuli, heart rate 30, Stable? standby pacing? Unstable immediate TCP?

 

[AmeriMedic21]

assessment, high flow oxygen, and high flow diesel.

 

[Aprz]

If you open up your ACLS booklet or index card to bradycardia, check out the part that says

Signs or symptoms of poor perfusion caused by the bradycardia?
(eg, acute altered mental status, ongoing chest pain, hypotension or other signs of shock)

and then it has arrows going to Adequate Perfusion and another one to Poor Perfusion.

 

[usalsfyre]

assessment,

Sure.

high flow oxygen,

Granted, the scenario gives very little information, but in the absence of hypoxia, what the heck is high concentration (I don't know of many EMS agencies that have access to true high FLOW O2) going to do?

and high flow diesel.

Perhaps treating the bradycardia (with TCP or chronotropic pharmacologic agents) can avoid the need for a dangerous, possibly detrimental to the patient transport.

 

[MrBrown]

We need more information, what was is the history and assessment findings on this bloke?

What type of bradycardia is it? 12 lead ECG?

It sounds like he is crook, lets get a drip in him and hang up a litre of fluid, give some atropine and see what happens

 

[JPINFV]

assessment, high flow oxygen, and high flow diesel.

 

[Chief Complaint]

72 year old, very low BP, alert to loud verbal stimuli, but when he responds he makes jokes and then goes back to only responding to verbal stimuli, heart rate 30, Stable? standby pacing? Unstable immediate TCP?

Definitely not stable due to the low BP and altered LOC. Fluids are a must if we are just treating based on the limited information that we have. .5mg of Atropine and pacing would be my next move.

 

[medictruth]

Fluids, Atropine 0.5mg and pacing if needed, oh and boogy to the hospital.

 

[Shishkabob]

How about we get an EKG before we go about any treatment modalities?

 

[WelshMedic]

72 year old, very low BP, alert to loud verbal stimuli, but when he responds he makes jokes and then goes back to only responding to verbal stimuli, heart rate 30, Stable? standby pacing? Unstable immediate TCP?

Get a notebook and write the good ones down.......


Sounds like an unstable bradycardia, I'd want a 12 lead and review of his Med's before taking any definitive action. If warranted I'd start with an IV push of atropine (0,5-3mg, titrated) and consider external pacing with midazolam and fentanyl for sedation and analgesia.

WM

 

[the_negro_puppy]

Toa ll you people saying atropine? what if he has a 3rd degree AV block?

This pt needs a 12 lead ECG with a good thorough history. Sounds like cardiogenic shock to me. Either way he needs ALS in the form of drug interventions or TCP, possible fluid challange and may need treeatment for ACS depending on ECG findings.

 

[Chief Complaint]

Toa ll you people saying atropine? what if he has a 3rd degree AV block?

This pt needs a 12 lead ECG with a good thorough history. Sounds like cardiogenic shock to me. Either way he needs ALS in the form of drug interventions or TCP, possible fluid challange and may need treeatment for ACS depending on ECG findings.

I guess i just assumed that since the OP didnt mention a high grade block that there wasnt one. After reading the post again, there are a few pieces of the puzzle that are left out, so you are right, its tough to come up with a difinitive treatment plan.

I dont think that giving .5mg Atropine will do much harm, it just wont affect the rhythm if its a high grade block. I still wouldnt be pushing meds without a 12 lead though.

HEY OP, CAN YOU PLEASE COME BACK AND GIVE US SOME MORE INFORMATION ABOUT THE CALL?

 

[fast65]

Well, it would be nice to know exactly what rhythm it is (1st, 2nd, 3rd degree block?). Based on the limited info available, we need 12-leads and a thorough history first and foremost. Depending on the rhythm we could try 0.5 mg of atropine, but I'm thinking a dopamine drip or TCP, as well as some fluids.

 

[NomadicMedic]

How low is a "low BP"? Did you check a sugar to see if that's why he's altered?

Like everyone else has said, 12 lead first. Then a fluid challenge, then maybe Atropine or TCP.

I'm not thinking Dopamine unless I can't improve perfusion with the Atropine or electricity.

 

[WelshMedic]

Op

I guess we are pretty much al reading from the same textbook page,here

I'm not sure I'd go with the fluid option but,well, unless the OP is a little more forthcoming then I think that everything has been said already.

Carl.