Re: Wednesday Challenge: Mind your Fe's, P's and T's

[Guest guest]

Gene,

I am glad to see the challenges back. With your permission, I will be using

these as scenarios for my Basic through Advanced students. They should really

make them think.

Jeanne E. Amis, RN, LP

Education Director

Marfa City/County EMS

wegandy@... wrote:

> An elderly man is the restrained driver of an older pickup which rearends a

> car which is stopped for a traffic signal. The collision is low impact and

> doesn't really cause any damage to either vehicle. Witnesses say the pickup

> driver was slumped over the wheel at the time of impact. They did not see

> any seizure activity and the man regained consciousness in 3-4 minutes, and

> was awake but somewhat confused when fire department first responders

> arrived. His LOC improved rapidly and he said he had just come from his

> doctor's office where he received an " iron IV. "

>

> Question: For what conditions is parental iron infusion given?

>

> BP was 110/74, Resp 15 and non-labored, Pulse regular at 112, skin cool,

> pale, and diaphoretic. There was no pedal edema. Patient denies chest pain

> but feels nauseated.

>

> FOR EMT-BASICS AND EMT-I's: Describe your on-scene managment for this

> patient, your transport priority, and management enroute.

>

> FOR PARAMEDICS:

>

> ECG showed sinus tachycardia. The P wave was notched ( " twin peaks " ), 0.10

> sec in duration, and the space between the " mountain peaks " of the P wave was

> 0.04 sec. The QRS was an RS complex of 0.08 duration, the R wave was 10 mm

> high, and the T wave was symetrical in leads II and III and and varied in

> height from 8 mm to 11 mm.

>

> What is the significance of the notched " twin peaks " P wave and what is it

> called?

>

> What is the significance of this T wave and what are some possible causes of

> the condition that it reflects?

>

> With only a 3-lead ECG available, what possible conditions might this patient

> have?

>

> Is there any relation between the history of " iron IV " and the ECG findings?

>

> Describe your on-scene, transport priorities, and enroute management.

>

> This ought to keep y'all busy fer awhile. Don't be bashful. I don't know

> any more than what I've told you, do not know the past medical history nor

> the Dx in the ER. So what do y'all think?

>

> Gene

>

> E. Gandy, JD, LP

> EMS Professions Program

> Tyler Junior College

> Tyler, TX

>

>

[Guest guest]

Please, everyone, feel free to use the challenges in any way you want, and

also to build on them and add to them. And please add some of your own.

Gene

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

I don't think so, but that's a VERY good guess.

Gene

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

What about an iron deficiency from dialysis.....as most end stage renal

disease patients go through...Patients that are on dialysis for any length of

time usually have iron deficencies that are normally corrected with an " Iron

I.V. " ...The ECG changes from the electrolyte deficiencies?? And the " double

peaks " on the P wave....possibly called " P mitrale " ???

Randall

[Guest guest]

Does this pt have Lupus?

Christy

Wednesday Challenge: Mind your Fe's, P's and T's

> An elderly man is the restrained driver of an older pickup which rearends

a

> car which is stopped for a traffic signal. The collision is low impact and

> doesn't really cause any damage to either vehicle. Witnesses say the

pickup

> driver was slumped over the wheel at the time of impact. They did not see

> any seizure activity and the man regained consciousness in 3-4 minutes,

and

> was awake but somewhat confused when fire department first responders

> arrived. His LOC improved rapidly and he said he had just come from his

> doctor's office where he received an " iron IV. "

>

> Question: For what conditions is parental iron infusion given?

>

> BP was 110/74, Resp 15 and non-labored, Pulse regular at 112, skin cool,

> pale, and diaphoretic. There was no pedal edema. Patient denies chest

pain

> but feels nauseated.

>

> FOR EMT-BASICS AND EMT-I's: Describe your on-scene managment for this

> patient, your transport priority, and management enroute.

>

> FOR PARAMEDICS:

>

> ECG showed sinus tachycardia. The P wave was notched ( " twin peaks " ),

0.10

> sec in duration, and the space between the " mountain peaks " of the P wave

was

> 0.04 sec. The QRS was an RS complex of 0.08 duration, the R wave was 10

mm

> high, and the T wave was symetrical in leads II and III and and varied in

> height from 8 mm to 11 mm.

>

> What is the significance of the notched " twin peaks " P wave and what is

it

> called?

>

> What is the significance of this T wave and what are some possible causes

of

> the condition that it reflects?

>

> With only a 3-lead ECG available, what possible conditions might this

patient

> have?

>

> Is there any relation between the history of " iron IV " and the ECG finding

s?

>

> Describe your on-scene, transport priorities, and enroute management.

>

> This ought to keep y'all busy fer awhile. Don't be bashful. I don't know

> any more than what I've told you, do not know the past medical history nor

> the Dx in the ER. So what do y'all think?

>

> Gene

>

> E. Gandy, JD, LP

> EMS Professions Program

> Tyler Junior College

> Tyler, TX

>

>

>

[Guest guest]

Right ON! Yes, it's P Mitrale. What does it indicate?

GG

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

P Mitrale due to left atrial enlargement? and/or block between intranodal

pathways?

kathi

[Guest guest]

Yes!!! Now how about the T wave?

gg

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

> Now how about the T wave?

Appears elevated?? could be indicative of hyperkalemia.....variable

height--possible ischemia and/or neurological??

(am i on the right track????!!!!!)

kathi

[Guest guest]

Yes, you're on the right track. Keep on!!!

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX