Saturday, 20 March 2010

12 year old male: Chief complaint: Palpitations

Here's a case submitted by Bob Sullivan, NREMT-P from New Castle County EMS in Wilmington, DE.

The case occurred six years ago so certain details are missing. However, there is more than enough here to discuss the most relevant points about the case.

The patient was a 12 year old male whose only complaint was palpitations.

The patient's pulse was extremely rapid. However, he appeared to be perfusing adequately and the blood pressure was stable.

A 12-lead ECG was captured.

And another.

Online Medical Control was contacted and the treating paramedic was advised to watch the patient's blood pressure and cardiovert if the patient became unstable.

The patient converted after the ambulance went over a bump. Unfortunately, a post-conversion 12-lead ECG was not recorded.

At the time, Mr. Sullivan was a new paramedic. He states that his co-workers felt that he should have given adenosine, since a 12 year old "could not be in VT." He also mentions that he's gotten different interpretations from each doctor he's shown it to.

The case has been bothering him ever since.

What do you think is the best field treatment for a patient like this?

What do you think of Online Medical Control's advice?

What do you think is wrong with this patient?