RedAirplane
Forum Asst. Chief
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I was obviously on the BLS side of this but want to better understand that the ALS practitioner does, and why.
BLS:
40 y.o F (athlete) pt presents to aid station before race asking for a blood pressure check because she feels "unusual." The BP turns out to be 160/100.
This reading concerns her. She says that she will not participate in the race, and that this is very concerning, because she manages her blood pressure well despite Hx of HTN and with her meds, she doesn't go above 140 systolic. You confirm she took her HTN meds this morning.
You ask a little more about why she felt the need to come get her BP checked, and she says he is having CP 3/10, localized, but occasionally radiating to the abd in which case it becomes 6/10. With her permission, you do more of an assessment. (-) JVD (-) pedal edema (-) SOB (-) N/V, L/S clear bilat.
PMHx: MI w/ stent, HTN. Pt states this feels like her MI but "not quite as bad" the pain is "slightly less"
ASA withheld per protocol (pt is on blood thinners)
ALS responds Code 3
ALS:
Handoff indicates all of the above. Environment is an increasingly cold and windy marina.
Repeat BP: 190/100, HR 110.
Adminster ASA 324 mg on scene then move into the rig for EKG, then txp Code 2 to cardiac center.
Questions:
For the EMT to understand, what would the big clues to the paramedic be in this case? Give ASA or not? (Possible upside vs downside if the pt is already on blood thinners?)
Code 2 vs Code 3 to the hospital? What treatments to give enroute, if any? I am not in a transport/911 role so some high level understanding of this would be appreciated.
Also, was the systolic BP going up? What does that mean? Or can the error between one reading and another cuff/practitioner be as high as 30 mmHg?
Would you have given NTG? Are you strongly suspecting cardiac, or is your indication to transport purely precautionary?
(Side note: I was extremely happy with the paramedics on this particular call. They were like ducks. Calm and collected above the surface, but vigorous below the surface. Able to hook up the monitor etc while casually conversing with us and the pt, not panicking the patient with eight firefighter/paramedics circling the patient barking questions, but rather having the scribe hovering in earshot secretly jotting everything down, gurney stand back until needed, ambulance parked facing the right direction for patient loading and easy egress... seemed very well thought out from a "how the patient would feel" perspective.)
BLS:
40 y.o F (athlete) pt presents to aid station before race asking for a blood pressure check because she feels "unusual." The BP turns out to be 160/100.
This reading concerns her. She says that she will not participate in the race, and that this is very concerning, because she manages her blood pressure well despite Hx of HTN and with her meds, she doesn't go above 140 systolic. You confirm she took her HTN meds this morning.
You ask a little more about why she felt the need to come get her BP checked, and she says he is having CP 3/10, localized, but occasionally radiating to the abd in which case it becomes 6/10. With her permission, you do more of an assessment. (-) JVD (-) pedal edema (-) SOB (-) N/V, L/S clear bilat.
PMHx: MI w/ stent, HTN. Pt states this feels like her MI but "not quite as bad" the pain is "slightly less"
ASA withheld per protocol (pt is on blood thinners)
ALS responds Code 3
ALS:
Handoff indicates all of the above. Environment is an increasingly cold and windy marina.
Repeat BP: 190/100, HR 110.
Adminster ASA 324 mg on scene then move into the rig for EKG, then txp Code 2 to cardiac center.
Questions:
For the EMT to understand, what would the big clues to the paramedic be in this case? Give ASA or not? (Possible upside vs downside if the pt is already on blood thinners?)
Code 2 vs Code 3 to the hospital? What treatments to give enroute, if any? I am not in a transport/911 role so some high level understanding of this would be appreciated.
Also, was the systolic BP going up? What does that mean? Or can the error between one reading and another cuff/practitioner be as high as 30 mmHg?
Would you have given NTG? Are you strongly suspecting cardiac, or is your indication to transport purely precautionary?
(Side note: I was extremely happy with the paramedics on this particular call. They were like ducks. Calm and collected above the surface, but vigorous below the surface. Able to hook up the monitor etc while casually conversing with us and the pt, not panicking the patient with eight firefighter/paramedics circling the patient barking questions, but rather having the scribe hovering in earshot secretly jotting everything down, gurney stand back until needed, ambulance parked facing the right direction for patient loading and easy egress... seemed very well thought out from a "how the patient would feel" perspective.)