• Scene – IV, 12-lead, EKG, O2, NTG, ASA, CBG, vitals
• En route – Vitals, 12-lead, amiodarone 150 mg, IV #2
• Hospital – monitor
• Response to treatment – chest pain went away and SOB got better
• Disposition – Pt states he felt better with the oxygen. He had palpitations with runs of V-TAC, but remained CAO.
• Transported to hospital
• Elliot Williams, Paramedic Woodburn Ambulance
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Ventricular tachycardia
• Myocardial Infarction
• Electrolyte abnormalities: hypokalemia, hypomagnesemia, hypocalcemia
• Recreational drug use (e.g., cocaine)
• Medication overdose (e.g., tricyclic antidepressants
• Congestive heart failure
• Pacemaker failure
• Patient states – “I can’t breathe and I need oxygen. If my heart stops, I don’t want anything done to me. I have had a lot of things done and they wanted to put a pacemaker in and I would not let them.”
• Clammy, SOB
• EKG – SR with PVC and runs of V-TAC
• CBG – 133
• GCS – 15
The monitor demonstrates a run of what appears to be ventricular tachycardia. This patient expressed a desire for minimal intervention; a difficult scenario for the clinical team managing this patient. This patient appears stable and medication therapy is a reasonable first choice. Cardioversion should be considered with unstable patients with this arrhythmia. This is a concerning condition which, if sustained, could lead to cardiac arrest as one potential outcome.
-Dr. David Spiro
• Gender: Male
• Age: 71 years
• Height: Not Available
• Weight: Not Available
• Temperature: Not Available
• Heart Rate: 97-200
• Blood Pressure: 138/89
• Respiratory Rate: 22
• Pulse Oximetry: 97% RA
Difficulty breathing; palpitations
History Medical
• PMH: CHF
• Allergies: None
• Dispatch info: SOB; Patient took nitroglycerin (NTG) ~ 2 hours ago with a little relief
• Lives at home with family
• Non-smoker
• Lasix, lisinopril, carvedilol, clopidogrel
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