Guest guest Posted December 27, 2000 Report Share Posted December 27, 2000 Well, with just that little bit of information, what you see is what you get. First, get the poodle out of there (no medical reason, I just dont like poodles). Put him on oxygen, ask about recent trauma, expose/palpate the chest and note response, listen to breath sounds, get some ASA down him, attach the AED for good measure. Our basics could give NTG with careful attention to the BP. You have to treat this as a cardiac incident. Hopefully a MICU unit will show up soon. [texasems-L] Chest Pain Scenario You are a Firefighter / Paramedic working as a BLS first responder. Christmas Eve; 1900 Hrs, you are called to the house of a 43 y/o WM living with parents in the older part of town. Upon your arrival mom meets you at the door with her prized miniature poodle in hand. She has a very concerned look on her face and rushes you inside. She says " Please don't let my son die! It's got to be his heart " Upon entry into the house you note an average build man lying on the couch clutching his chest. He c/o chest pain X 3days. V/S B/P 140 / 80, Pulse 110, Respirations 20 & NL. No Meds, Allergies, or PPMH. Last meal was southern fried at 1700. Ideas? __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2000 Report Share Posted December 28, 2000 Give him some Mylanta or Malox. His problem is going to be GERDs (gastroesophageal reflux disease). But because of things such as scope of practice and protocols sit back and baby-sit and do what you can until Txp team arrives. Note: This Happens to me on a regular basis. Have done little experiment Cardiac Work up. Had a blood pressure of 210/120, p 100, r 22, before I through in the towel to get meds on board. Except for S/S labs came out great. This gentleman also probably smokes and drinks alcohol occasionally. LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 28, 2000 Report Share Posted December 28, 2000 Why not Zantac IV? >From: water13985@... >Reply-To: egroups >To: egroups >Subject: Re: [texasems-L] Chest Pain Scenario >Date: Thu, 28 Dec 2000 12:31:30 EST > >Give him some Mylanta or Malox. His problem is going to be GERDs >(gastroesophageal reflux disease). But because of things such as scope of >practice and protocols sit back and baby-sit and do what you can until Txp >team arrives. > >Note: This Happens to me on a regular basis. Have done little experiment >Cardiac Work up. Had a blood pressure of 210/120, p 100, r 22, before I >through in the towel to get meds on board. Except for S/S labs came out >great. This gentleman also probably smokes and drinks alcohol occasionally. > > LP > > > _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2000 Report Share Posted December 29, 2000 Zantac (Ranitidine) IV works great. It is a part of our chest pain protocol for that very reason. Out of the realm of BLS first-responders, though. Re: [texasems-L] Chest Pain Scenario > >Date: Thu, 28 Dec 2000 12:31:30 EST > > > >Give him some Mylanta or Malox. His problem is going to be GERDs > >(gastroesophageal reflux disease). But because of things such as scope of > >practice and protocols sit back and baby-sit and do what you can until Txp > >team arrives. > > > >Note: This Happens to me on a regular basis. Have done little experiment > >Cardiac Work up. Had a blood pressure of 210/120, p 100, r 22, before I > >through in the towel to get meds on board. Except for S/S labs came out > >great. This gentleman also probably smokes and drinks alcohol occasionally. > > > > LP > > > > > > > > _________________________________________________________________ > Get your FREE download of MSN Explorer at http://explorer.msn.com > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2000 Report Share Posted December 29, 2000 *POOF* The poodle has been banished. Oxygen? What device and flow? No recent trauma. Upon exposure you notice the skin is warm and dry with a pink to red appearance. There is no unusual responce to palpation of chest. BBS Clear = X 4 Pulse Ox is 100% on room air. ASA? Attach an AED to a patient with a pulse? (Your AED does not have a monitor) You do not have NTG available. MICU is still several minutes out. Anything else? --- Petty wrote: > Well, with just that little bit of information, what > you see is what you get. First, get the poodle out > of there (no medical reason, I just dont like > poodles). Put him on oxygen, ask about recent > trauma, expose/palpate the chest and note response, > listen to breath sounds, get some ASA down him, > attach the AED for good measure. Our basics could > give NTG with careful attention to the BP. > You have to treat this as a cardiac incident. > Hopefully a MICU unit will show up soon. > > [texasems-L] Chest Pain Scenario > > > You are a Firefighter / Paramedic working as a BLS > first responder. Christmas Eve; 1900 Hrs, you are > called to the house of a 43 y/o WM living with > parents > in the older part of town. Upon your arrival mom > meets you at the door with her prized miniature > poodle > in hand. She has a very concerned look on her > face > and rushes you inside. She says " Please don't let > my > son die! It's got to be his heart " Upon entry > into > the house you note an average build man lying on > the > couch clutching his chest. He c/o chest pain X > 3days. > V/S B/P 140 / 80, Pulse 110, Respirations 20 & > NL. > No Meds, Allergies, or PPMH. Last meal was > southern > fried at 1700. > > > Ideas? > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2000 Report Share Posted December 29, 2000 Patient asks why you want to give him Mylanta or Maalox for his heart. He tells you he thought those were for heartburn. How can we determine GERD (which I have and am very familiar) from the given situation? How many BLS Engine Companies carry these meds anyway? (Not trying to flame, but not the right treatment for this patient) Patient denies smoking and alcohol consumption. Be careful with assumptions..... Anything else? --- water13985@... wrote: > Give him some Mylanta or Malox. His problem is going > to be GERDs > (gastroesophageal reflux disease). But because of > things such as scope of > practice and protocols sit back and baby-sit and do > what you can until Txp > team arrives. > > Note: This Happens to me on a regular basis. Have > done little experiment > Cardiac Work up. Had a blood pressure of 210/120, p > 100, r 22, before I > through in the towel to get meds on board. Except > for S/S labs came out > great. This gentleman also probably smokes and > drinks alcohol occasionally. > > LP > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2000 Report Share Posted December 29, 2000 You are a BLS Engine Company. IV meds will arrive on the MICU shortly, but not an option now. The system in your area doesn't carry Zantac. You have All necessary firefighting gear, equipment, and such instruments. Also on your rig are an AED, BLS oxygen bag, trauma kit, C-Collars, etc...... Anything else? --- " Mike , LP " wrote: > Why not Zantac IV? > > > >From: water13985@... > >Reply-To: egroups > >To: egroups > >Subject: Re: [texasems-L] Chest Pain Scenario > >Date: Thu, 28 Dec 2000 12:31:30 EST > > > >Give him some Mylanta or Malox. His problem is > going to be GERDs > >(gastroesophageal reflux disease). But because of > things such as scope of > >practice and protocols sit back and baby-sit and do > what you can until Txp > >team arrives. > > > >Note: This Happens to me on a regular basis. Have > done little experiment > >Cardiac Work up. Had a blood pressure of 210/120, p > 100, r 22, before I > >through in the towel to get meds on board. Except > for S/S labs came out > >great. This gentleman also probably smokes and > drinks alcohol occasionally. > > > > LP > > > > > > > > _________________________________________________________________ > Get your FREE download of MSN Explorer at > http://explorer.msn.com > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2000 Report Share Posted December 29, 2000 Ok..I got here late but how about some simple basic steps first, 1. Position of comfort 2. High flow O2..breath slow in and out through your nose..sir 3. Medical Hx? 4. If yes and the patient has Nitro..has he take any today? 5. Vitals 6. If 4 is yes to meds and no to dose, and the B\P allows say above 110 systolic..help him take a dose of his nitro and monitor his vitals. 7. Radio the incoming ALS unit of your findings and interventions...Keep the patient calm until the big guys get on scene.. > >Reply-To: egroups >To: egroups >Subject: Re: [texasems-L] Chest Pain Scenario >Date: Fri, 29 Dec 2000 09:34:50 -0800 (PST) > >You are a BLS Engine Company. IV meds will arrive on >the MICU shortly, but not an option now. The system >in your area doesn't carry Zantac. You have All >necessary firefighting gear, equipment, and such >instruments. Also on your rig are an AED, BLS oxygen >bag, trauma kit, C-Collars, etc...... > >Anything else? > > >--- " Mike , LP " wrote: > > Why not Zantac IV? > > > > > > >From: water13985@... > > >Reply-To: egroups > > >To: egroups > > >Subject: Re: [texasems-L] Chest Pain Scenario > > >Date: Thu, 28 Dec 2000 12:31:30 EST > > > > > >Give him some Mylanta or Malox. His problem is > > going to be GERDs > > >(gastroesophageal reflux disease). But because of > > things such as scope of > > >practice and protocols sit back and baby-sit and do > > what you can until Txp > > >team arrives. > > > > > >Note: This Happens to me on a regular basis. Have > > done little experiment > > >Cardiac Work up. Had a blood pressure of 210/120, p > > 100, r 22, before I > > >through in the towel to get meds on board. Except > > for S/S labs came out > > >great. This gentleman also probably smokes and > > drinks alcohol occasionally. > > > > > > LP > > > > > > > > > > > > > >_________________________________________________________________ > > Get your FREE download of MSN Explorer at > > http://explorer.msn.com > > > > > > >__________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2000 Report Share Posted December 29, 2000 , you're having too much fun with this. What was the pt. doing prior to the onset of the chest pains, both immediately and was there anything unusual or out of the ordinary during 24-hours prior to the onset of pain? To: egroups Date sent: Fri, 29 Dec 2000 09:27:11 -0800 (PST) Send reply to: egroups Subject: Re: [texasems-L] Chest Pain Scenario [ Double-click this line for list subscription options ] *POOF* The poodle has been banished. Oxygen? What device and flow? No recent trauma. Upon exposure you notice the skin is warm and dry with a pink to red appearance. There is no unusual responce to palpation of chest. BBS Clear = X 4 Pulse Ox is 100% on room air. ASA? Attach an AED to a patient with a pulse? (Your AED does not have a monitor) You do not have NTG available. MICU is still several minutes out. Anything else? --- Petty wrote: > Well, with just that little bit of information, what > you see is what you get. First, get the poodle out > of there (no medical reason, I just dont like > poodles). Put him on oxygen, ask about recent > trauma, expose/palpate the chest and note response, > listen to breath sounds, get some ASA down him, > attach the AED for good measure. Our basics could > give NTG with careful attention to the BP. > You have to treat this as a cardiac incident. > Hopefully a MICU unit will show up soon. > > [texasems-L] Chest Pain Scenario > > > You are a Firefighter / Paramedic working as a BLS > first responder. Christmas Eve; 1900 Hrs, you are > called to the house of a 43 y/o WM living with > parents > in the older part of town. Upon your arrival mom > meets you at the door with her prized miniature > poodle > in hand. She has a very concerned look on her > face > and rushes you inside. She says " Please don't let > my > son die! It's got to be his heart " Upon entry > into > the house you note an average build man lying on > the > couch clutching his chest. He c/o chest pain X > 3days. > V/S B/P 140 / 80, Pulse 110, Respirations 20 & > NL. > No Meds, Allergies, or PPMH. Last meal was > southern > fried at 1700. > > > Ideas? > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2000 Report Share Posted December 29, 2000 Prefer nasal cannula unless pt is complaining of shortness of breath as well. By " pink to red " are you indicating an abnormality? Urticaria? ASA stands for Acetyl-Salicylic Acid (aspirin). There is no reason for BLS responders NOT to attach an AED to a patient in extreme chest pain, even though he has a pulse (for now). Pulses come... and pulses go. If the pulse goes, best to have the darn thing attached. Note that " attached " does not have to mean " turned on. " Check his back. Ask about recent activities. This is all real standard stuff... [texasems-L] Chest Pain Scenario > > > > > > You are a Firefighter / Paramedic working as a BLS > > first responder. Christmas Eve; 1900 Hrs, you are > > called to the house of a 43 y/o WM living with > > parents > > in the older part of town. Upon your arrival mom > > meets you at the door with her prized miniature > > poodle > > in hand. She has a very concerned look on her > > face > > and rushes you inside. She says " Please don't let > > my > > son die! It's got to be his heart " Upon entry > > into > > the house you note an average build man lying on > > the > > couch clutching his chest. He c/o chest pain X > > 3days. > > V/S B/P 140 / 80, Pulse 110, Respirations 20 & > > NL. > > No Meds, Allergies, or PPMH. Last meal was > > southern > > fried at 1700. > > > > > > Ideas? > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2000 Report Share Posted December 29, 2000 You said older house on Christmas Eve (cold weather?). Does the pt stay in a different area of the house than the parents, say w/ questionable heating system? CO poisoning is another possibility to be ruled out. This could account for red skin, 100% SaO2, & chest pain from hypoxemia...if Hx indicates this possibility give 100% O2 & no ASA. > > *POOF* The poodle has been banished. > > Oxygen? What device and flow? > > No recent trauma. Upon exposure you notice the skin > is warm and dry with a pink to red appearance. There > is no unusual responce to palpation of chest. > > BBS Clear = X 4 Pulse Ox is 100% on room air. > > ASA? > > Attach an AED to a patient with a pulse? (Your AED > does not have a monitor) You do not have NTG > available. > > MICU is still several minutes out. Anything else? > > > > --- Petty wrote: > > Well, with just that little bit of information, what > > you see is what you get. First, get the poodle out > > of there (no medical reason, I just dont like > > poodles). Put him on oxygen, ask about recent > > trauma, expose/palpate the chest and note response, > > listen to breath sounds, get some ASA down him, > > attach the AED for good measure. Our basics could > > give NTG with careful attention to the BP. > > You have to treat this as a cardiac incident. > > Hopefully a MICU unit will show up soon. > > > > [texasems-L] Chest Pain Scenario > > > > > > You are a Firefighter / Paramedic working as a BLS > > first responder. Christmas Eve; 1900 Hrs, you are > > called to the house of a 43 y/o WM living with > > parents > > in the older part of town. Upon your arrival mom > > meets you at the door with her prized miniature > > poodle > > in hand. She has a very concerned look on her > > face > > and rushes you inside. She says " Please don't let > > my > > son die! It's got to be his heart " Upon entry > > into > > the house you note an average build man lying on > > the > > couch clutching his chest. He c/o chest pain X > > 3days. > > V/S B/P 140 / 80, Pulse 110, Respirations 20 & > > NL. > > No Meds, Allergies, or PPMH. Last meal was > > southern > > fried at 1700. > > > > > > Ideas? > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2000 Report Share Posted December 29, 2000 Re 's scenario, should we be worried about our own environment here? Headaches for days, pink looking skin? Hmmmmmmmmm What kind of heating equipment does the house have? gg Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2000 Report Share Posted December 29, 2000 Gotta agree with Mr. Sharp here. I haven't heard any PQRST (except for T) or SAMPLE (except for the S) questions here. I would like to know: What was the patient doing prior to the pain onset? What provoked the pain or relieves the pain? Does the pain radiate? Severity, 0/10 and what is his reference point for 10? How long? You said three days, is it three days continuously? On and off? Worse then better then worse? If it has been going on for three days, what has changed to make you call us today? Any other symptoms? (nausea, diarrhea, abd pain, etc) Allergies to medications (always good to find out about that Morphine or Aspirin allergy before you give it) Any medications taken, including prescription, over the counter, herbal, dietary supplements, weight loss products, body building products? Any drugs or alcohol in the last 72 hours? (yes, I ask EVERYONE) Any medical history? (in this case, previous cardiac or respiratory problems?) Also, any psychiatric problems for which he is recieving care? When/what was his last meal? (southern, right?) See first and last questions above, we should have covered E here. But with the warm, dry skin I would like to know what he has been doing today? Any yard work? Any work around carbon monoxide producing items? Any arguements with family members? What is the current weather conditions with this patient? What do I notice about the house and the room he is in? How are his parents acting? I don't think I missed anything. Webb, LP FLW EMS, MO ----Original Message Follows---- Reply-To: egroups To: egroups Subject: Re: [texasems-L] Chest Pain Scenario Date: Fri, 29 Dec 2000 12:20:35 -0600 (CST) , you're having too much fun with this. What was the pt. doing prior to the onset of the chest pains, both immediately and was there anything unusual or out of the ordinary during 24-hours prior to the onset of pain? To: egroups Date sent: Fri, 29 Dec 2000 09:27:11 -0800 (PST) Send reply to: egroups Subject: Re: [texasems-L] Chest Pain Scenario [ Double-click this line for list subscription options ] *POOF* The poodle has been banished. Oxygen? What device and flow? No recent trauma. Upon exposure you notice the skin is warm and dry with a pink to red appearance. There is no unusual responce to palpation of chest. BBS Clear = X 4 Pulse Ox is 100% on room air. ASA? Attach an AED to a patient with a pulse? (Your AED does not have a monitor) You do not have NTG available. MICU is still several minutes out. Anything else? --- Petty wrote: > Well, with just that little bit of information, what > you see is what you get. First, get the poodle out > of there (no medical reason, I just dont like > poodles). Put him on oxygen, ask about recent > trauma, expose/palpate the chest and note response, > listen to breath sounds, get some ASA down him, > attach the AED for good measure. Our basics could > give NTG with careful attention to the BP. > You have to treat this as a cardiac incident. > Hopefully a MICU unit will show up soon. > > [texasems-L] Chest Pain Scenario > > > You are a Firefighter / Paramedic working as a BLS > first responder. Christmas Eve; 1900 Hrs, you are > called to the house of a 43 y/o WM living with > parents > in the older part of town. Upon your arrival mom > meets you at the door with her prized miniature > poodle > in hand. She has a very concerned look on her > face > and rushes you inside. She says " Please don't let > my > son die! It's got to be his heart " Upon entry > into > the house you note an average build man lying on > the > couch clutching his chest. He c/o chest pain X > 3days. > V/S B/P 140 / 80, Pulse 110, Respirations 20 & > NL. > No Meds, Allergies, or PPMH. Last meal was > southern > fried at 1700. > > > Ideas? > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2000 Report Share Posted December 30, 2000 1. Position of comfort is very good. 2. High flow O2 is excellent. 3. No PPMH. 4. No 5. B/P 140 / 80, Pulse 110, Respirations 20 & NL. 6. No Nitro 7. ok.... :-) The key was in the parts you missed..... --- Gene Bell wrote: > Ok..I got here late but how about some simple basic > steps first, > 1. Position of comfort > 2. High flow O2..breath slow in and out through your > nose..sir > 3. Medical Hx? > 4. If yes and the patient has Nitro..has he take any > today? > 5. Vitals > 6. If 4 is yes to meds and no to dose, and the B\P > allows say above 110 > systolic..help him take a dose of his nitro and > monitor his vitals. > 7. Radio the incoming ALS unit of your findings and > interventions...Keep the > patient calm until the big guys get on scene.. > > > > > >Reply-To: egroups > >To: egroups > >Subject: Re: [texasems-L] Chest Pain Scenario > >Date: Fri, 29 Dec 2000 09:34:50 -0800 (PST) > > > >You are a BLS Engine Company. IV meds will arrive > on > >the MICU shortly, but not an option now. The > system > >in your area doesn't carry Zantac. You have All > >necessary firefighting gear, equipment, and such > >instruments. Also on your rig are an AED, BLS > oxygen > >bag, trauma kit, C-Collars, etc...... > > > >Anything else? > > > > > >--- " Mike , LP " wrote: > > > Why not Zantac IV? > > > > > > > > > >From: water13985@... > > > >Reply-To: egroups > > > >To: egroups > > > >Subject: Re: [texasems-L] Chest Pain Scenario > > > >Date: Thu, 28 Dec 2000 12:31:30 EST > > > > > > > >Give him some Mylanta or Malox. His problem is > > > going to be GERDs > > > >(gastroesophageal reflux disease). But because > of > > > things such as scope of > > > >practice and protocols sit back and baby-sit > and do > > > what you can until Txp > > > >team arrives. > > > > > > > >Note: This Happens to me on a regular basis. > Have > > > done little experiment > > > >Cardiac Work up. Had a blood pressure of > 210/120, p > > > 100, r 22, before I > > > >through in the towel to get meds on board. > Except > > > for S/S labs came out > > > >great. This gentleman also probably smokes and > > > drinks alcohol occasionally. > > > > > > > > LP > > > > > > > > > > > > > > > > > > > >_________________________________________________________________ > > > Get your FREE download of MSN Explorer at > > > http://explorer.msn.com > > > > > > > > > > > >__________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2000 Report Share Posted December 30, 2000 Patient watching TV following a meal 2 hours ago. Nothing out of the ordinary. This is a call I ran that night..... --- " Barry D. Sharp " wrote: > , you're having too much fun with this. What > was the pt. doing > prior to the onset of the chest pains, both > immediately and was > there anything unusual or out of the ordinary during > 24-hours prior > to the onset of pain? > > > > > > To: egroups > > Date sent: Fri, 29 Dec 2000 09:27:11 -0800 > (PST) > Send reply to: egroups > Subject: Re: [texasems-L] Chest Pain > Scenario > > [ Double-click this line for list subscription > options ] > > *POOF* The poodle has been banished. > > Oxygen? What device and flow? > > No recent trauma. Upon exposure you notice the skin > is warm and dry with a pink to red appearance. > There > is no unusual responce to palpation of chest. > > BBS Clear = X 4 Pulse Ox is 100% on room air. > > ASA? > > Attach an AED to a patient with a pulse? (Your AED > does not have a monitor) You do not have NTG > available. > > MICU is still several minutes out. Anything else? > > > > --- Petty wrote: > > Well, with just that little bit of information, > what > > you see is what you get. First, get the poodle > out > > of there (no medical reason, I just dont like > > poodles). Put him on oxygen, ask about recent > > trauma, expose/palpate the chest and note > response, > > listen to breath sounds, get some ASA down him, > > attach the AED for good measure. Our basics could > > give NTG with careful attention to the BP. > > You have to treat this as a cardiac incident. > > Hopefully a MICU unit will show up soon. > > > > [texasems-L] Chest Pain Scenario > > > > > > You are a Firefighter / Paramedic working as a > BLS > > first responder. Christmas Eve; 1900 Hrs, you > are > > called to the house of a 43 y/o WM living with > > parents > > in the older part of town. Upon your arrival > mom > > meets you at the door with her prized miniature > > poodle > > in hand. She has a very concerned look on her > > face > > and rushes you inside. She says " Please don't > let > > my > > son die! It's got to be his heart " Upon entry > > into > > the house you note an average build man lying on > > the > > couch clutching his chest. He c/o chest pain X > > 3days. > > V/S B/P 140 / 80, Pulse 110, Respirations 20 & > > NL. > > No Meds, Allergies, or PPMH. Last meal was > > southern > > fried at 1700. > > > > > > Ideas? > > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2000 Report Share Posted December 30, 2000 Nasal Cannula is ok, but did a NRB ever hurt anyone? Pink to red is an abnormailty. No Urticaria, only redness. I knew what ASA was, I meant why do you want to give an ASA? I disagree with ataching an AED to a conscious patient in with minimal S/S and CP. Several reasons why? 1. Why scare the hell out of the patient with those super maxi size AED pads? (He'll love you when they rip them off in the ER later) 2. All Protocols that I have seen say attach AED only in the case of pulselessness. (How long does it take to attach them anyway?) 3. Why waste the pads when you probably won't be using them. (This would be a substancial financial burden if we attached them to every CP. How many CP's in your experience will need defibrillation. Not a large percentage from my experience, so attaching AED pads to every CP pt is unreasonable.) IMHO Back is clear. Recent activities include a meal 2 hours ago and lying on the sofa watching TV since. --- Petty wrote: > Prefer nasal cannula unless pt is complaining of > shortness of breath as > well. By " pink to red " are you indicating an > abnormality? Urticaria? ASA > stands for Acetyl-Salicylic Acid (aspirin). > There is no reason for BLS responders NOT to attach > an AED to a patient in > extreme chest pain, even though he has a pulse (for > now). Pulses come... > and pulses go. If the pulse goes, best to have the > darn thing attached. > Note that " attached " does not have to mean " turned > on. " Check his back. > Ask about recent activities. This is all real > standard stuff... > [texasems-L] Chest Pain Scenario > > > > > > > > > You are a Firefighter / Paramedic working as a > BLS > > > first responder. Christmas Eve; 1900 Hrs, you > are > > > called to the house of a 43 y/o WM living with > > > parents > > > in the older part of town. Upon your arrival > mom > > > meets you at the door with her prized > miniature > > > poodle > > > in hand. She has a very concerned look on her > > > face > > > and rushes you inside. She says " Please don't > let > > > my > > > son die! It's got to be his heart " Upon > entry > > > into > > > the house you note an average build man lying > on > > > the > > > couch clutching his chest. He c/o chest pain > X > > > 3days. > > > V/S B/P 140 / 80, Pulse 110, Respirations 20 > & > > > NL. > > > No Meds, Allergies, or PPMH. Last meal was > > > southern > > > fried at 1700. > > > > > > > > > Ideas? > > > > > > > __________________________________________________ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2000 Report Share Posted December 30, 2000 wins the Grand Prize. Today's Prize is a fabulous 3 day tour of the County Landfill. This prize package is worth a whopping $1.10. (The cost of the complimentary coffee, made from recycled coffee grounds found right on sight.) This is a real call I ran on the 22nd. The patient only C/O was pain in his chest. Ischemia I am sure, but there was no reason to believe due to a blockage. We don't carry NTG, and even after EMS arrivial he wasn't given any. The patient's skin was unusually pink, but not that " Bright Red " as described in the books. The house was uncomfortably warm, probably 80 - 85 degrees, not too unusual for older folks. The house had a gas space heater and was from all apperances very old. The flame was about 50% yellow and 50% blue. We suspected CO. We removed the patient, mom, and ourselves from the house and placed him on high flow O2 by NRB. After we told them of our suspicions mom states she has been having headaches since early November and mostly at night. The pt denied any HA at any time. We did a CO check and found a reading of 350 PPM. Keep in mind that 400 PPM is life threatening after 3 hours or so in an otherwize healty adult. We shut down the heater and ventilated the house until a reading of 2 - 5 PPM was reached. Hopefully they followed our advice and had the heater fixed. This call was a wake up for me. (I didn't even know I had nodded off.) As we all know, but keep in mind that all calls don't fit the textbook. This was an apparent CP and many of you clued in on that fact and went right for it. So did we at first. Also remember that CO will give misleading readings on a pulse oximeter! Happy New Year to all of you, E. Tate, LP Tyler, Texas --- Haschke wrote: > You said older house on Christmas Eve (cold > weather?). Does the pt stay in > a different area of the house than the parents, say > w/ questionable heating > system? CO poisoning is another possibility to be > ruled out. This could > account for red skin, 100% SaO2, & chest pain from > hypoxemia...if Hx > indicates this possibility give 100% O2 & no ASA. > > > > > *POOF* The poodle has been banished. > > > > Oxygen? What device and flow? > > > > No recent trauma. Upon exposure you notice the > skin > > is warm and dry with a pink to red appearance. > There > > is no unusual responce to palpation of chest. > > > > BBS Clear = X 4 Pulse Ox is 100% on room air. > > > > ASA? > > > > Attach an AED to a patient with a pulse? (Your > AED > > does not have a monitor) You do not have NTG > > available. > > > > MICU is still several minutes out. Anything else? > > > > > > > > --- Petty wrote: > > > Well, with just that little bit of information, > what > > > you see is what you get. First, get the poodle > out > > > of there (no medical reason, I just dont like > > > poodles). Put him on oxygen, ask about recent > > > trauma, expose/palpate the chest and note > response, > > > listen to breath sounds, get some ASA down him, > > > attach the AED for good measure. Our basics > could > > > give NTG with careful attention to the BP. > > > You have to treat this as a cardiac incident. > > > Hopefully a MICU unit will show up soon. > > > > > > [texasems-L] Chest Pain Scenario > > > > > > > > > You are a Firefighter / Paramedic working as a > BLS > > > first responder. Christmas Eve; 1900 Hrs, you > are > > > called to the house of a 43 y/o WM living with > > > parents > > > in the older part of town. Upon your arrival > mom > > > meets you at the door with her prized > miniature > > > poodle > > > in hand. She has a very concerned look on her > > > face > > > and rushes you inside. She says " Please don't > let > > > my > > > son die! It's got to be his heart " Upon > entry > > > into > > > the house you note an average build man lying > on > > > the > > > couch clutching his chest. He c/o chest pain > X > > > 3days. > > > V/S B/P 140 / 80, Pulse 110, Respirations 20 > & > > > NL. > > > No Meds, Allergies, or PPMH. Last meal was > > > southern > > > fried at 1700. > > > > > > > > > Ideas? > > > > > > > __________________________________________________ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2000 Report Share Posted December 30, 2000 wins the Grand Prize. Today's Prize is a fabulous 3 day tour of the County Landfill. This prize package is worth a whopping $1.10. (The cost of the complimentary coffee, made from recycled coffee grounds found right on sight.) This is a real call I ran on the 22nd. The patient only C/O was pain in his chest. Ischemia I am sure, but there was no reason to believe due to a blockage. We don't carry NTG, and even after EMS arrivial he wasn't given any. The patient's skin was unusually pink, but not that " Bright Red " as described in the books. The house was uncomfortably warm, probably 80 - 85 degrees, not too unusual for older folks. The house had a gas space heater and was from all apperances very old. The flame was about 50% yellow and 50% blue. We suspected CO. We removed the patient, mom, and ourselves from the house and placed him on high flow O2 by NRB. After we told them of our suspicions mom states she has been having headaches since early November and mostly at night. The pt denied any HA at any time. We did a CO check and found a reading of 350 PPM. Keep in mind that 400 PPM is life threatening after 3 hours or so in an otherwize healty adult. We shut down the heater and ventilated the house until a reading of 2 - 5 PPM was reached. Hopefully they followed our advice and had the heater fixed. This call was a wake up for me. (I didn't even know I had nodded off.) As we all know, but keep in mind that all calls don't fit the textbook. This was an apparent CP and many of you clued in on that fact and went right for it. So did we at first. Also remember that CO will give misleading readings on a pulse oximeter! Happy New Year to all of you, E. Tate, LP Tyler, Texas --- Haschke wrote: > You said older house on Christmas Eve (cold > weather?). Does the pt stay in > a different area of the house than the parents, say > w/ questionable heating > system? CO poisoning is another possibility to be > ruled out. This could > account for red skin, 100% SaO2, & chest pain from > hypoxemia...if Hx > indicates this possibility give 100% O2 & no ASA. > > > > > *POOF* The poodle has been banished. > > > > Oxygen? What device and flow? > > > > No recent trauma. Upon exposure you notice the > skin > > is warm and dry with a pink to red appearance. > There > > is no unusual responce to palpation of chest. > > > > BBS Clear = X 4 Pulse Ox is 100% on room air. > > > > ASA? > > > > Attach an AED to a patient with a pulse? (Your > AED > > does not have a monitor) You do not have NTG > > available. > > > > MICU is still several minutes out. Anything else? > > > > > > > > --- Petty wrote: > > > Well, with just that little bit of information, > what > > > you see is what you get. First, get the poodle > out > > > of there (no medical reason, I just dont like > > > poodles). Put him on oxygen, ask about recent > > > trauma, expose/palpate the chest and note > response, > > > listen to breath sounds, get some ASA down him, > > > attach the AED for good measure. Our basics > could > > > give NTG with careful attention to the BP. > > > You have to treat this as a cardiac incident. > > > Hopefully a MICU unit will show up soon. > > > > > > [texasems-L] Chest Pain Scenario > > > > > > > > > You are a Firefighter / Paramedic working as a > BLS > > > first responder. Christmas Eve; 1900 Hrs, you > are > > > called to the house of a 43 y/o WM living with > > > parents > > > in the older part of town. Upon your arrival > mom > > > meets you at the door with her prized > miniature > > > poodle > > > in hand. She has a very concerned look on her > > > face > > > and rushes you inside. She says " Please don't > let > > > my > > > son die! It's got to be his heart " Upon > entry > > > into > > > the house you note an average build man lying > on > > > the > > > couch clutching his chest. He c/o chest pain > X > > > 3days. > > > V/S B/P 140 / 80, Pulse 110, Respirations 20 > & > > > NL. > > > No Meds, Allergies, or PPMH. Last meal was > > > southern > > > fried at 1700. > > > > > > > > > Ideas? > > > > > > > __________________________________________________ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2000 Report Share Posted December 31, 2000 You know, it may sound dumb and I know we nixed the poodle a little while ago, but it wouldn't hurt to check the poodle somewhat or ask the family if he/she is acting normally. If this is environmental (as in CO posioning) wouldn't the poodle show some signs also? and quicker than humans? Jana [texasems-L] Chest Pain Scenario > > > > > > > > > You are a Firefighter / Paramedic working as a BLS > > > first responder. Christmas Eve; 1900 Hrs, you are > > > called to the house of a 43 y/o WM living with > > > parents > > > in the older part of town. Upon your arrival mom > > > meets you at the door with her prized miniature > > > poodle > > > in hand. She has a very concerned look on her > > > face > > > and rushes you inside. She says " Please don't let > > > my > > > son die! It's got to be his heart " Upon entry > > > into > > > the house you note an average build man lying on > > > the > > > couch clutching his chest. He c/o chest pain X > > > 3days. > > > V/S B/P 140 / 80, Pulse 110, Respirations 20 & > > > NL. > > > No Meds, Allergies, or PPMH. Last meal was > > > southern > > > fried at 1700. > > > > > > > > > Ideas? > > > > > > __________________________________________________ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 1, 2001 Report Share Posted January 1, 2001 On Mon, 1 Jan 2001 00:16:33 -0600 " JL Jordan " writes: > If this is environmental (as in CO posioning) > wouldn't the poodle show some signs also? and quicker than humans? Kinda like a canary in a coal mine... before methane detectors, coal miners would bring a caged canary into the mine. Over goes the canary, the miners bail. One problem tho.... how can you tell when a poodle is showing signs of hypoxemia? I thought they ALWAYS acted like that :-). " Leadership is action, not position " Larry RN CFRN NREMTP ....and some other stuff ________________________________________________________________ GET INTERNET ACCESS FROM JUNO! Juno offers FREE or PREMIUM Internet access for less! Join Juno today! For your FREE software, visit: http://dl.www.juno.com/get/tagj. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 1, 2001 Report Share Posted January 1, 2001 On Mon, 1 Jan 2001 00:16:33 -0600 " JL Jordan " writes: > If this is environmental (as in CO posioning) > wouldn't the poodle show some signs also? and quicker than humans? Kinda like a canary in a coal mine... before methane detectors, coal miners would bring a caged canary into the mine. Over goes the canary, the miners bail. One problem tho.... how can you tell when a poodle is showing signs of hypoxemia? I thought they ALWAYS acted like that :-). " Leadership is action, not position " Larry RN CFRN NREMTP ....and some other stuff ________________________________________________________________ GET INTERNET ACCESS FROM JUNO! Juno offers FREE or PREMIUM Internet access for less! Join Juno today! For your FREE software, visit: http://dl.www.juno.com/get/tagj. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 1, 2001 Report Share Posted January 1, 2001 Great thought. In fact, Little Fifi may be the first to succumb. gg In a message dated 12/31/2000 11:40:52 PM US Mountain Standard Time, medicgirl@... writes: << Subj: Re: [texasems-L] Chest Pain Scenario You know, it may sound dumb and I know we nixed the poodle a little while ago, but it wouldn't hurt to check the poodle somewhat or ask the family if he/she is acting normally. If this is environmental (as in CO posioning) wouldn't the poodle show some signs also? and quicker than humans? Jana - Quote Link to comment Share on other sites More sharing options...
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