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Old 12-18-2011, 12:21 PM   #1
addictedforever
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passing out from overexertion?


Okay here's the situation... You get called out for a 20 y/o female who has passed out they think from overexertion. You arrive and there is a person administring first aid, trying to get the pt. to respond. She has squeezed his hand, he reports to you, but that has been the extent of her response.

She was playing broomball, felt tired, then when they tried to move her to get her inside, she went limp. They moved her inside and laid her on the floor which is where she is now. She is soaking wet, and freezing cold. (It is -10C/10F outside.) Whole body is rigid. They have people rubbing her extremeties, and have warmed blankets covering her.

Just after you get there, she goes limp, completely, 100% limp. Breathing goes to almost nothing, very shallow breaths every 10-20 seconds. Radial pulse-nonexistent. Carotid pulse-very weak, irregular 35 bpm. B/P-86/44

They are able to tell you that she has suspected heart murmur and that she has passed out from overexertion about three months ago, but it wasn't the same as this time.

Action plan? What are your tho'ts?


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Old 12-18-2011, 01:09 PM   #2
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Airway, OPA or NPA to start and assist ventilations.
Put her on the monitor and see what you got.
Follow ACLS Guidelines, Rule out the Hs+Ts, prepare to pace, Epi, Dopamine, etc.
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Old 12-18-2011, 01:45 PM   #3
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OPA,BVM,12 lead, ACLS guidelines, IVx2, BGL off of sharp, pupils?
If no change after treatment of bradycardia, intubate.
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Old 12-18-2011, 01:50 PM   #4
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pupils nonreactive
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Old 12-18-2011, 01:50 PM   #5
18G
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It's definitely possible to have near or actual syncope due to over exertion. Syncope is self-limiting so if it is true syncope the patient usually rebounds pretty quickly. If the patient remains unresponsive than its not syncope.

What is a suspected heart murmur? Either you have one or you don't?

When I hear heart murmur and past episode of a similar nature, I would be asking if anyone knows how long the patient has had the heart murmur (congenital & getting worse?, normally asymptomatic?, see's a cardiologist?) and what is causing the heart murmur. A patient with a valve problem has a murmur and depending on which valve (usually mitral in younger person) can have decreased cardiac output and decreased exercise tolerance.

There can be an autonomic response during exertional states which can lead to presentations like you describe. The breathing problem isn't typical though.

As far as treatment, a 12-lead would be nice.. Blood glucose check. IV access. Fluid bolus. Oxygen. Airway management as needed. Assist breathing as needed. Get the wet clothes off and continue to passively warm. Atropine as indicated. Consider pacing.

What do her lungs sound like? SpO2? PMH?

Last edited by 18G; 12-18-2011 at 01:53 PM.
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Old 12-18-2011, 01:54 PM   #6
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Quote:
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It's definitely possible to have near or actual syncope due to over exertion. Syncope is self-limiting so if it is true syncope the patient usually rebounds pretty quickly. If the patient remains unresponsive than its not syncope.

What is a suspected heart murmur? Either you have one or you don't?

When I hear heart murmur and past episode of a similar nature, I would be asking if anyone knows how long the patient has had the heart murmur (congenital & getting worse?, normally asymptomatic?, see's a cardiologist?) and what is causing the heart murmur. A patient with a valve problem has a murmur and depending on which valve (usually mitral in younger person) can have decreased cardiac output and decreased exercise tolerance.

There can be an autonomic response during exertional states which can lead to presentations like you describe. The breathing problem isn't typical though.

As far as treatment, a 12-lead would be nice to determine if the problem is cardiac related. Blood glucose check. IV access. Fluid bolus. Oxygen. Airway management as needed. Assist breathing as needed. Get the wet clothes off and continue to passively warm.
The pt. was tested for HOCM, but they did not know the results of the test as it had just been a couple days ago that she'd been tested. The drs were suspecting that she might have HOCM because her brother has it. At this point she was not seeing a cardiologist and did not have a family dr.
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Old 12-18-2011, 01:58 PM   #7
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What do her lungs sound like? SpO2? PMH?
Lungs-slight crackles all regions
SpO2-84%
I'm not familiar with what PMH means
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Old 12-18-2011, 02:00 PM   #8
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Lungs-slight crackles all regions
SpO2-84%
I'm not familiar with what PMH means
PMH = Past Medical History.

A patient in this condition with altered LOC, bradycardia, hypotension, change of resp status, and crackles, is going to get immediate pacing unless I have a Medic partner who can get atropine on board before I'm ready to pace.

Was a 12-lead acquired?

Last edited by 18G; 12-18-2011 at 02:02 PM.
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Old 12-18-2011, 02:02 PM   #9
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PMH = Past Medical History.
Okay, thanks...

PMH--non-outstanding besides her episode where she passed out three months ago, except during that episode she hyperventilated

12 lead was not acquired. We do not have that ability on our unit. (a very small volunteer unit in rural northwestern ontario, canada)

Last edited by addictedforever; 12-18-2011 at 02:08 PM.
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Old 12-18-2011, 02:05 PM   #10
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12-lead?
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