Here’s a case submitted by Bob Sullivan from New Castle County EMS.
EMS is called to the residence of a 41 year old female with chest pain.
Onset: Sudden while sweeping the floor
Provoke: Nothing makes the pain better or worse
Radiate: The pain does not radiate
Time: 20 minutes prior to EMS arrival
Past medical history: MI, Pacemaker/ICD
Pulse: Very rapid
SpO2: Not registering
The cardiac monitor is attached.
A 12-lead ECG is captured.
The patient is placed on O2 via NRB @ 15 LPM and IV access is established.
What do you think the paramedics should do next?
*** UPDATE ***
Paramedics give 150 mg amiodarone over 10 minutes via piggyback infusion.
The patient’s BP drops to 90/48 and the patient’s clinical status is observed to deteriorate.
Synchronized cardioversion is performed.
The rhythm is now narrow complex but extremely fast and unstable.
The ICD delivers a shock and the patient is observed to be in VF.
After waiting a few seconds (to see what the ICD is going to do) paramedics shock the VF.
The rhythm starts to stabilize and the patient’s BP comes up to 142/74.
Are you ready to drop this patient off at the emergency department?