The patient responds to painful stimuli with a grimace.
Respirations are shallow.
Past medical history: MI, pacemaker/ICD, renal insufficiency
Medications: Numerous - unable to locate at the time of evaluation
Radial pulses are absent.
The cardiac monitor is attached and shows strange, slow waves.
By the appearance of the ECG paramedics are surprised that the patient is not in cardiac arrest.
They prepare the patient for immediate transcutaneous pacing (TCP).
Paramedics report capture at 60 PPM and 80 mA.
The patient regains consciousness but is not alert.
He is not conversant but nods his head to simple questions and manages to mouth the word, "Sick."
What do you think is wrong with this patient?
What do you think about the current course of treatment?
See also:
58 year old male CC: Unconscious - Conclusion
1. Check K⁺ as the cause of the broad QRS; he has renal impairment; probably on ACEI etc.
ReplyDelete2. Turn up the juice - not capturing consistently; could check this by timing carotid pulse to ECG deflections.
-TCP is the right treatment at this time, although Im not confidant that they are getting a good capture with current setting. This is my thoughts on one possibility for the cause. Let me know what you think.
ReplyDeleteRenal insuff.
Pacemaker is not working
Wide bizzare QRS, and due to Hx my gut is Hyperkalemia. without medication list, labs or a 12 lead obviously this is only a grab out of the Hs, and Ts and from seeing renal patients with deadly high levels of potassium.
Tx, call doc may not want to consider not doing anything more than pacing and supportive care.
I have 25 min transport time to a community ER
-Request if calcium chloride, sodium bicarb, albuterol sulfate, lasix to begin protecting the body.