Pre-Hospital Questions & Resources

[musketeer]

Hi , in the interests of education can we discuss(in broad, confidential terms) some medical signs and symptoms to get the old grey matter ticking? I was recently on an American EMS site where just this was occuring and it seemed to me to be a good idea to stop myopic diagnoses

[PFO]

ok lets discuss the use of Atropine in a Mobitz type 2 heartblock. Would you or wouldnt you and why. There have been a few studies done on this and it would be interesting to know other peoples thoughts.

[musketeer]

Ok without further info , I would say it could be used but may be ineffective. "Treat the patient not the machine"

[PFO]

my understanding of it is that with mobitz type 2 and complete heart block
there are ischaemic changes occuring, whereas with first degree and second degree type 1 atrioventricular block ischaemic changes are less likely. So with the use of atropine in the former blocks mentioned you could assume that their would be an increased risk of exaserbating the ischaemia yet atropine is still used in these cases dependant on protocol. I think its a case of damned if ya do and damned if ya dont, specially in a pre-hospital environment.

[Ambul8]

my understanding of it is that with mobitz type 2 and complete heart block
there are ischaemic changes occuring, whereas with first degree and second degree type 1 atrioventricular block ischaemic changes are less likely. So with the use of atropine in the former blocks mentioned you could assume that their would be an increased risk of exaserbating the ischaemia yet atropine is still used in these cases dependant on protocol. I think its a case of damned if ya do and damned if ya dont, specially in a pre-hospital environment.

wat he said

[musketeer]

Tough call with any ischemic change. We're not born with xray eyes and can only treat as we see. Unfortunatly protocols are out of date by the time they reach us all u can do is bend em not break em!

[musketeer]

How about a 26yr old, c/o l hemianopia, able to move on command but altered sensation, nil dyspnea, nil dysphagia, nil sensory disturbances, o/e NAD bp slight elevation but second set reveals upward trend, perl, on further questioning reveals he felt disorientated on raising from bed and stumbled and struck head. Not sure if h/a started then or later, h/a 4/10, speech is slow and cautious but otherwise normal.
I bussed off site but hospital returned to site before I woke up that afternoon(night shift).
Was I right to be thinking of....................................

[PFO]

[quote="musketeer"]Tough call with any ischemic change. We're not born with xray eyes and can only treat as we see. Unfortunatly protocols are out of date by the time they reach us all u can do is bend em not break em![/quote] even with a three leed, ischaemic changes may sometimes be picked up , and also via patient presentation and Hx, cardiac enzymes such as troponin ( which you can get kits for ) . We definately do not diagnose, but treat the presenting signs and symptoms, Yes its nice to have various diagnostic equipment, and if indications are there and protocols in place there shouldnt be any issue.

[musketeer]

Agreed but three lead is insufficient to diagnose between blocks accuratly and I've not worked for a service that advocates troponin test pre hospital

[PFO]

[quote="musketeer"]Agreed but three lead is insufficient to diagnose between blocks accuratly and I've not worked for a service that advocates troponin test pre hospital[/quote] yes your quite right, but would we classify a minesite as pre-hospital as many do carry troponin kits, some even strep kits but thats quickly being phased out as streptokinase i dont think is a preferred choice anymore.

[musketeer]

Agreed but I've worked on about six mine sites and haven't come across either test kit! Does that mean I've worked on cowboy unit's? In two cases definately!!!
Thanks PFO, the grey matter got a workout, love argueing with myself!!!!

[PFO]

[quote="musketeer"]How about a 26yr old, c/o l hemianopia, able to move on command but altered sensation, nil dyspnea, nil dysphagia, nil sensory disturbances, o/e NAD bp slight elevation but second set reveals upward trend, perl, on further questioning reveals he felt disorientated on raising from bed and stumbled and struck head. Not sure if h/a started then or later, h/a 4/10, speech is slow and cautious but otherwise normal.
I bussed off site but hospital returned to site before I woke up that afternoon(night shift).
Was I right to be thinking of....................................[/quote] how long is a piece of string, could be a simple migraine coming on. was he photophobic, any distonia, was the alterered sensation distal or centralised.what was his gcs,bsl,pmhx,hr, ? nausea.what kind of altered sensation ie burn,sting,numb. was he proprioreceptive. what part of his head did he hit, possibly occipital? neckpain ? with bp trending, were they done sitting, laying (could of had a simple vaso vagal,)skin colour,hr. and as you said in a previous post treat the patient. plus all the disease processes susch as tumors, legions, infections , injury,carotid artery aneurysm etc...ASNSW are currentlyconsidering the use of thrombolytics in pre-hospital care thus requiring both troponin kits and 12 lead ecg with main indication for use being standard STEMI .

[musketeer]

Ok !!! Settle petal!!
Nil pmhx of any significance,nil migraine,nil photophobia, numbness affected two limbs leg and arm on same side,gcs was 15 , BSL 4.8, nil neckpain, temporal region struck nil evidence of trauma(occured 6hrs previous)he was lying down when bilat BP was done, skin colour pale not diaphoretic.............

[PFO]

[quote="musketeer"]Ok !!! Settle petal!!
Nil pmhx of any significance,nil migraine,nil photophobia, numbness affected two limbs leg and arm on same side,gcs was 15 , BSL 4.8, nil neckpain, temporal region struck nil evidence of trauma(occured 6hrs previous)he was lying down when bilat BP was done, skin colour pale not diaphoretic.............[/quote] Ok so were thinking TIA hehehehheheh. lol.
was he obese or a pisshead, not that common for a 26 year old.

[musketeer]

Neither obese nor a piss tank. Athletic build, (quite nice actually) I didn't say that Yea I did think TIA and gave him a quick stroke test but inconclusive. Handballed to hospital cause I like covering my bum!!