So, we you are administering pain medication to a patient whom you are also administering fluid, especially through a large gauge catheter that flows really well. It doesn't really matter much how slowly your push your 1 ml of medication into the extension set. Because it probably won't get to the patient until you start running the fluid again.
That being said, don't open the roller clamp full bore right afterwards. It might end up in someone in the ambulance vomiting from getting pain meds too fast.
Not that this happened to me, I'm just saying.
Wednesday, August 29, 2012
Friday, August 24, 2012
First Chest Pain Call...Updated
So, thanks to a comment in this post from Christopher, I have been led on the path that the first patient I did a 12 lead on as a Paramedic may have had something called Ashman Phenomenon.
Ashman Phenomenon, by my understanding, is when a patient in Atrial Fibrillation has a long R to R interval followed by a relatively short R to R interval. During the long R to R, I guess the corresponding refractory period is also lengthened, to the point where it isn't quite finished by the next beat, causing aberrant conduction, typically mirroring a Right Bundle Branch Block, but sometimes other patterns too.
I originally stated that the patient had A.fib with occasional aberrant conduction, which appeared to be a Right Bundle Branch Block.
I dug up the 12 lead that I saved and I saw that it didn't appear to be a right bundle branch block, but in fact a left bundle branch block.
But enough talk, here are 2 of the EKGs I did....
I guess Ashman phenomenon is occasionally mistook for a PVC, but seeing as how this patient had multiple perfusing abnormal beats in a row at a reasonable rate, it seemed more like a block.
Lead II in monitor mode wasn't very useful in showing the aberrant beats(they barely registered as squiggles), in retrospect I could've used MCL1, that might have shown the rhythm better, but I guess that will have to wait for next time.
It is interesting though, because what I read about Ashman Phenomena on the internet (the source of all credible information) it seems to usually just be a single beat. But if this patient's heart couldn't refract (Is a word, no?) fast enough, I guess it would make sense for multiple beats in a row to conduct abnormally.
Now my question for discussion would be, Did this patient prescription to Diltiazem increase her aberrant beats or not?
Any comments?
Ashman Phenomenon, by my understanding, is when a patient in Atrial Fibrillation has a long R to R interval followed by a relatively short R to R interval. During the long R to R, I guess the corresponding refractory period is also lengthened, to the point where it isn't quite finished by the next beat, causing aberrant conduction, typically mirroring a Right Bundle Branch Block, but sometimes other patterns too.
I originally stated that the patient had A.fib with occasional aberrant conduction, which appeared to be a Right Bundle Branch Block.
I dug up the 12 lead that I saved and I saw that it didn't appear to be a right bundle branch block, but in fact a left bundle branch block.
But enough talk, here are 2 of the EKGs I did....
 |
| Ignore the Wandering Baseline... |
I guess Ashman phenomenon is occasionally mistook for a PVC, but seeing as how this patient had multiple perfusing abnormal beats in a row at a reasonable rate, it seemed more like a block.
Lead II in monitor mode wasn't very useful in showing the aberrant beats(they barely registered as squiggles), in retrospect I could've used MCL1, that might have shown the rhythm better, but I guess that will have to wait for next time.
It is interesting though, because what I read about Ashman Phenomena on the internet (the source of all credible information) it seems to usually just be a single beat. But if this patient's heart couldn't refract (Is a word, no?) fast enough, I guess it would make sense for multiple beats in a row to conduct abnormally.
Now my question for discussion would be, Did this patient prescription to Diltiazem increase her aberrant beats or not?
Any comments?
Tuesday, August 21, 2012
Finally there...or just started
I have been working as a Paramedic now for...approximately 3 weeks.
I have been thinking like a Paramedic for much longer.
For Paramedic Bag-of-Tricks, I have administered exactly 150 mcg of fentanyl.
My first 12 lead interpretation as a Paramedic consisted of a diabetic chest pain patient....
How is A. fib with inconsistent aberrancy sound?
Go figure that it couldn't be sinus, or STEMI, or ANYTHING straight forward. No, it has to be a pt. with some narrow QRS once and a while, then wide RBBB-like QRS for a little while.
It wasn't runs of V-Tach, because it stated in a rate of the 60-70 bpm.
Luckily, when we got to the ED, the Tech already had an old copy of the Patient's EKG, and it looked the exact same.
Update (8/24/1): More information(or guessing and conjecture!) on Chest Pain patient here
I have been thinking like a Paramedic for much longer.
For Paramedic Bag-of-Tricks, I have administered exactly 150 mcg of fentanyl.
My first 12 lead interpretation as a Paramedic consisted of a diabetic chest pain patient....
How is A. fib with inconsistent aberrancy sound?
Go figure that it couldn't be sinus, or STEMI, or ANYTHING straight forward. No, it has to be a pt. with some narrow QRS once and a while, then wide RBBB-like QRS for a little while.
It wasn't runs of V-Tach, because it stated in a rate of the 60-70 bpm.
Luckily, when we got to the ED, the Tech already had an old copy of the Patient's EKG, and it looked the exact same.
Update (8/24/1): More information(or guessing and conjecture!) on Chest Pain patient here
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