OK. Not "combat related" but will be a good review for some, good info for new guys.
Backround: An urban/suburban E.M.S. system in the northeast of the U.S., county run with a county medical and co medical directors that are both former paramedics, now emergency medical / special operations trained M.D.'s. System is run via single role A.L.S. organizations at the township level. Medical protocols are statewide based and progressive...for the most part.
Call: For a resp. distress.
Scene: Apartment complex for a 55 y/o female, apparent distress, is pale, and diaphoretic, apprehensive and when you get close to check pulse, no radial, weak carotid and is awake but lethargic.
V/S: B/P: 70P, HR: 130 and irregular, RR: 26 and labored, Lungs: rales but diminished, 12-lead: A-fib, rapid ventricular response with an obvious anterior wall M.I., some inferior elevation but under 1mm., an occasional P.V.C. 324 baby ASA given in field. Other treatments as well...
STEMI alert called. Transported to a PPCI capable hospital (bypassed a closer / farther PPCI is 5 mins. more away). Pt. remains awake. 12-lead and serial 12's show same and have both paramedic interpretation and transmitted to E.D. for attending M.D. review. M.D. agrees.
NOTE: Experienced medics and docs, please wait until new guys can give some answers here as I am sure you will know the answers...
QUESTIONS:
(1) What is a STEMI
(2): What do the rales represent?
(3): Why is the B/P low?
(4): Should CPAP be used or not used?
(5): If no I.V. access, what's the next step?
(6): Should you give Nitro?
(7): Why is the heart rate high?
(8): Do you treat heart rate?
(9): How do you treat low B/P?
(10): Does it make sense to place combi-pads in case of peri-arrest / sudden V-fib arrest?
@AKkeith. This is a good case for you brother, since your starting off. If you don't understand something here, ask. I will fill you all in on my treatment and it was accepted and complemented by the attending and cardiologist. Just figure it would be cool to post since it is kind of uncommon to see all at once w/o being dead...
M.
Backround: An urban/suburban E.M.S. system in the northeast of the U.S., county run with a county medical and co medical directors that are both former paramedics, now emergency medical / special operations trained M.D.'s. System is run via single role A.L.S. organizations at the township level. Medical protocols are statewide based and progressive...for the most part.
Call: For a resp. distress.
Scene: Apartment complex for a 55 y/o female, apparent distress, is pale, and diaphoretic, apprehensive and when you get close to check pulse, no radial, weak carotid and is awake but lethargic.
V/S: B/P: 70P, HR: 130 and irregular, RR: 26 and labored, Lungs: rales but diminished, 12-lead: A-fib, rapid ventricular response with an obvious anterior wall M.I., some inferior elevation but under 1mm., an occasional P.V.C. 324 baby ASA given in field. Other treatments as well...
STEMI alert called. Transported to a PPCI capable hospital (bypassed a closer / farther PPCI is 5 mins. more away). Pt. remains awake. 12-lead and serial 12's show same and have both paramedic interpretation and transmitted to E.D. for attending M.D. review. M.D. agrees.
NOTE: Experienced medics and docs, please wait until new guys can give some answers here as I am sure you will know the answers...
QUESTIONS:
(1) What is a STEMI
(2): What do the rales represent?
(3): Why is the B/P low?
(4): Should CPAP be used or not used?
(5): If no I.V. access, what's the next step?
(6): Should you give Nitro?
(7): Why is the heart rate high?
(8): Do you treat heart rate?
(9): How do you treat low B/P?
(10): Does it make sense to place combi-pads in case of peri-arrest / sudden V-fib arrest?
@AKkeith. This is a good case for you brother, since your starting off. If you don't understand something here, ask. I will fill you all in on my treatment and it was accepted and complemented by the attending and cardiologist. Just figure it would be cool to post since it is kind of uncommon to see all at once w/o being dead...
M.
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