Quote:
Originally Posted by Trapper John
As I said before, cardiac cases scare the crap out of me - too many ways to screw up and only one way to get it right. Supportive care and transport is the priority here. This patients ECG is a mess and no time to interpret. I'm thinking pulmonary embolism and possible CHF. Elevate the patient, start IV (NS drip 10 gtt/min). O2 by mask 15L/min, morphine 5 mg IV, 80 mg lasix as Nurse Time said. Not sure about rotating tourniquets (that's a new one on me, so NT would you educate me?). The pO2 at 92% concerns me - possible respiratory acidosis if this has been going on for awhile. I would push an amp of bicarb. Transport to the nearest primary care facility (15 min by ground). This one is going to need a dDx by a cardiologist. I will try to decipher the ECG and post my dDx and Rx plan later. The primary goal at the moment is respiratory support and get him to the nearest primary care facility.
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Rotating tourniquets is very old school Tx for CHF. I believe it reduces pre-load. Inflate a cuff on 3 of 4 limbs at any one time. Come to think of it it's Tx of pulmonary edema, not CHF. Not this patient's problem, clearly.
Quote:
Originally Posted by Brush Okie
My first thought was cardiac tamponaid as well.
Does pt have recent history of chest trauma or infections/ fevers?
are there muffled heart sounds.
High flow O2
IV NS tko
No nitro or ferosimide due to low BP. Lasic has an initial vaso dilation effect initially before kicking out water. Same for MS. BP 50/30 is low woth low pulse pressure
I would consider Dopamine 2-10 ug/kg/min and external pacing.
Dopamine is only a short term fix. If heart sounds are muffled and he needs a paracenthisis this is the fix plus find out root cause ie infection, trauma etc etc.
If it is a basic bradycardia from a MI that needs to be treated asap as well not to mention he will probably wind up with cardio myopothy his rate was tachy, but I agree with the MI Dx.
Medevac to more equipped hospital.
BTW my spelling sucks on my best days, today is really bad so please forgive my lack of skills. Picture a gorilla pounding on a keyboard and that is me.
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50/30 is just barely enough to perfuse the beans. Would levophed be appropriate in this situation?
Trapper John, imdur and vasotec are chronic meds and likely taken earlier.
So, if the Pt. recieved nitro, could it cause bradycardia?