shadowmedic
Forum Ride Along
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Hi all,
I've got a scenario question I am curious how others out there would manage. I am also curious if any of you have any good resources on any studies that have been done relating to the topic. I have been doing some looking and have found some articles but nothing amazing.
I am a new medic still in my first 6 months of practice, looking for some advice!
So,
70's YO patient with CHF history and some other pretty standard co-morbidities, HTN, diabetes etc. You show up and obtain this history and find the patient to be sitting on the edge of the bed in severe respiratory distress. They are tripoding, some accessory muscle use, non verbal with a initial GCS of 10 (E3, V1, M6)
Lung sounds reveal rales throughout.
HR 90 NSR, SpO2 93 on home O2 at 4 lpm (increased from 2 lpm baseline), BP 118/78, ETCo2 40, RR 28. Skin slightly pale and mostly dry.
12-lead does not show a STEMI.
So you work on managing the airway with CPAP or BVM depending on how well she is maintaining her airway. But, this patient starts to become bradycardic starting by slowing to the 70's, 50's then further to 40s and 30s. Along with a decreasing LOC.
If you are working with this patient and see this trend, how long will you stick with focusing on managing the airway with assisting ventilations by CPAP/BVM and giving NTG as the BP allows, before you consider pacing this patient? Would you pace this patient?
My thought process is to do my best to improve oxygenation and ventilation in hopes to improve the HR and keep this patient from circling the drain and coding. But, what are the pro's / con's of moving to pacing? Ideally I would like to avoid increasing stress on the already overworked and failing heart.
I've got a scenario question I am curious how others out there would manage. I am also curious if any of you have any good resources on any studies that have been done relating to the topic. I have been doing some looking and have found some articles but nothing amazing.
I am a new medic still in my first 6 months of practice, looking for some advice!
So,
70's YO patient with CHF history and some other pretty standard co-morbidities, HTN, diabetes etc. You show up and obtain this history and find the patient to be sitting on the edge of the bed in severe respiratory distress. They are tripoding, some accessory muscle use, non verbal with a initial GCS of 10 (E3, V1, M6)
Lung sounds reveal rales throughout.
HR 90 NSR, SpO2 93 on home O2 at 4 lpm (increased from 2 lpm baseline), BP 118/78, ETCo2 40, RR 28. Skin slightly pale and mostly dry.
12-lead does not show a STEMI.
So you work on managing the airway with CPAP or BVM depending on how well she is maintaining her airway. But, this patient starts to become bradycardic starting by slowing to the 70's, 50's then further to 40s and 30s. Along with a decreasing LOC.
If you are working with this patient and see this trend, how long will you stick with focusing on managing the airway with assisting ventilations by CPAP/BVM and giving NTG as the BP allows, before you consider pacing this patient? Would you pace this patient?
My thought process is to do my best to improve oxygenation and ventilation in hopes to improve the HR and keep this patient from circling the drain and coding. But, what are the pro's / con's of moving to pacing? Ideally I would like to avoid increasing stress on the already overworked and failing heart.