Comments on: Looks like I’m getting it…

By: emtb210

emtb210 — Thu, 11 Feb 2010 01:48:21 +0000

I meant nitro for the second atropine. My bad!

By: emtb210

emtb210 — Thu, 11 Feb 2010 01:27:41 +0000

I’m just an EMT but am starting medic school in September. Did the atropine raise the bp up enough for the atropine? I know it has to be over 100 and was just wondering if that was what did it or did it just happen? Thanks!

By: medic22

medic22 — Mon, 25 Jan 2010 01:07:52 +0000

Walt, As I mentioned, my original thought was a beta blocker overdose. But since I was unable to ascertain if he did or did not take more than he claimed and I don’t carry enough Glucagon to make a difference, I was going down the symptomatic bradycardia route. Thinking his pressure was the culprit, he got a fluid bolus first, and there was no rate change. The atropine quickly brought him up to 70 (from 47) and he became pain free with one SL nitro. There was no appreciable pressure change after the nitro. Following the Atropine and fluid, he just looked better and and his mentation was a bit more crisp that it had been on arrival.

By: Walt Trachim

Walt Trachim — Fri, 22 Jan 2010 19:54:38 +0000

Nice job – good documentation, too. And it sounds like you’re off to a good start. I’m with Chris, BTW – a right-sided 12 lead would have been good to have, but it does take a little bit of time simply because you’re duplicating what you did on the left.

That said, I would likely have done the same as you with respect to the Atropine and the NTG afterward so long as he was able to hold his pressure. Curious – did you grab a BP after the NTG? And if you did was there any significant change?

No reason – just asking…

By: medic22

medic22 — Mon, 11 Jan 2010 21:19:34 +0000

Yeah… Great point. I was on the edge with the beta blocker overdose, but he was adamant that he hadn’t taken too much and that he hadn’t done anything outside the norm. So, in this case, I feel the fluid bolus and atropine, followed by nitrates and ASA was the prudent choice. (I’m still not convinced he didn’t take a few more Metoprolol than he should have…)

By: Texasmedic

Texasmedic — Mon, 11 Jan 2010 21:09:23 +0000

Not sure what your protocols say but if he overdosed on metoprolol.. just saying… then perhaps maybe 1mg glucagon would help in this case…i dont recall the antidote for norvasc/clonidine but a beta blocker od would be glucagon…

By: Kyle

Kyle — Mon, 11 Jan 2010 17:26:21 +0000

Congrats. Ran my first ALS solo about 6 months ago and spent the next 3 days telling anybody who would listen. 6 months as a medic I still get the butterflies in my stomach when a “good” run comes in

By: Medic 22

Medic 22 — Mon, 11 Jan 2010 17:18:38 +0000

Yes, fluid bolus in first, before the Atropine. He wound up getting 500ml and his pressure came up to 106/88, but his rate was still slow. (I grabbed for the Atropine when I looked at the monitor and his rate was 47.) My first though was that he had overdosed himself on the metoprolol. We did not run a right sided 12.

And thanks Chris…this is the kind of feedback I want. My preceptor was watching and helping, doing what I asked him to do, and nothing more. He told me the treatment was excellent and he was playing little tricks to see if I’d take the bait. For example, he grabbed the ASA and the nitro at the same time. I told him to hold on the nitro til I ran in some fluid and he smiled. You’re right… this Medic stuff is fun…and I really like being able to get from point A to point B on my own. This call ran just like a class scenario, but it’s so much more rewarding doing it for real.

By: Ckemtp - Life Under the Lights

Ckemtp - Life Under the Lights — Mon, 11 Jan 2010 16:39:50 +0000

Symptomatic bradyardia on your first ALS Tech call? Sweet. It doesn’t happen that way as often as you think.

I worry about the Atropine on this… a HR in the 50s isn’t terrible, although it sounds like the patient tolerated it well and improved with the dosage. I would have been curious to see what his right sided EKG looked like with the hypotension and slight bradycardia. Did you attempt a fluid bolus?

I’m just doing what I do to my students, btw. My advice to them is always this: “Know WHY you’re doing what you’re doing. Have a GOOD REASON to do EVERYTHING.” Simple is almost always better.

Good job though, this Medic stuff is fun.

By: Theresa Jones

Theresa Jones — Mon, 11 Jan 2010 06:39:48 +0000

Cool! I’ll always remember my first too. Sounds like you’re having fun. Enjoy and take care!