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Old 05-10-2013, 18:55   #16
Sdiver
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Quote:
Originally Posted by Trapper John View Post
Huh Oh! Add 5 mg Epinephrine to the IV turn up the drip rate.
Okay.
Would you like to do anything else?
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Old 05-10-2013, 19:01   #17
Trapper John
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Still going with ruptured ectopic pregnancy. Go faster? Check vitals.
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Old 05-10-2013, 19:57   #18
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Still going with ruptured ectopic pregnancy. Go faster? Check vitals.
Okay .... Increase deisel.

Anyone have anything else they'd like to add, ... do, .... ask ????
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Old 05-11-2013, 00:03   #19
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Sounds like a surgical abdomen.

Kick the stretcher does that hurt?
1. ruptured ectopic
2. ruptured ectopic
3. perforated appy

2 large bore lines, draw blood for type and cross and BHCG level on arrival.
Here's a bonus round:

What two "studies" could you theoretically do en route in the back of the truck to make a diagnosis and call ahead for a prepped OR.

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Old 05-13-2013, 23:22   #20
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Answer to above scenario ... Ectopic Pregnancy in early stages of rupture.

Trapper .... good job in catching that.

If anyone would have asked, the Pt. was Gravida: 4, Para: 1 (she miscarried the first 2, had a full term for her 3rd, and then miscarried the 4th ). The last miscarriage was 8 months ago. She does not know if she is pregnant again. She hasn't checked.

All in all, good job in RO the appendicitis, but narrowing it down to the EP.

Quote:
Ectopic Pregnancy
What is an Ectopic Pregnancy? An Ectopic Pregnancy (EP) is a condition in which a fertilized egg has attached itself to anywhere other than the Uterine wall. Most EPs happen in either one of the fallopian tubes. “ This type of ectopic pregnancy is known as a tubal pregnancy.” (1) This type of EP happens in roughly 95% of the cases seen. The other areas prone to EPs would be for the egg to attach itself to the abdomen, the cervix, or within the ovary itself. Because the fallopian tubes were not designed to sustain a growing embryo, if an embryo were to attach itself to one of the tubular walls, as the embryo grows, it will stretch the fallopian tube to where it could eventually burst. The fallopian tubes are not designed to support a growing embryo. They are merely transport vessels, transporting an egg from the ovaries to the uterus. Studies have shown that, “An ectopic pregnancy occurs in about one in 50 pregnancies.” (2) So this is a very common occurrence and as EMS providers, this is something that we must be wary of in female patients complaining of lower abdominal pain. The most common occurrence of EPs happening are with woman “35 to 44 years of age.”(3) But an EP can happen in any sexually active age group.
The only true way to determine if a woman does have an EP is in the clinical or hospital setting. Through the use of either a pelvic or transvaginal ultrasound, can an MD determine if this is an EP. “Treatment options for ectopic pregnancy include observation, laparoscopy, laparotomy, and medication. Selection of these options is individualized. Some ectopic pregnancies will resolve on their own without the need for any intervention, while others will need urgent surgery due to life-threatening bleeding. However, because of the risk of rupture and potential dire consequences, most women with a diagnosed ectopic pregnancy are treated with medications or surgery.” (2)
As EMS providers the best treatment plan for a suspected EP would be to provide comfort care, pain management and treat for shock (if present). If the pain is present on the RightLower Quadrant of any female, don’t be fooled into thinking it is an appendix issue. A detailed physical exam along with a detailed history is important. Even in the above simulation, having to deal with the “language barrier” presented, getting a detailed history can be the difference in alerting the receiving facility to have the appropriate people standing by to deal with either an appendicitis or an ectopic pregnancy.
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Old 05-13-2013, 23:24   #21
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Huh Oh! Add 5 mg Epinephrine to the IV turn up the drip rate.
I could be a real prick and ask .... What's your drip rate? (show your work)

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Old 05-14-2013, 07:45   #22
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I could be a real prick and ask .... What's your drip rate? (show your work)

No not all. I would have asked the same of my students at SFS back in the day. I will be more complete with my responses in the future

For this one, if I recall correctly, a standard drip rate would be 60 gtt/min? This would deliver ~250 ml/h assuming a standard drip chamber and IV tubing. I was assuming a 1 L bag of NS to which I added 5 mg Epinephrine (1.25 mg/h). I would turn up the drip rate to 120 gtt/min to deliver 2.5 mg Epi/h.

You or the Docs may need to correct me on this, working from memory here.

Thanks for the challenge. Please post another one when you can. This is fun!
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