Im an EMT, i had this call the other day, wanted to get your guys' input

[ranchoemt]

ALS Ambulance and ALS Fire Engine arrive on scene at the same time to residence for a reported "Diff Breather". At front door is reporting party(patient's daughter) directing crew into the kitchen. Crew enters kitchen to find 57 year old male lying left lateral in mild to moderate distress. Patient is awake and tracking. Patient is able to answer questions and states "I had trouble breathing in, I passed out and went down to the floor. Its never happened before."

Daughter reports "He was playing racket ball earlier and has had a gradual onset of difficulty breathing since playing. Patient has no medical Hx, no allergies and no meds. 911 was called when patient passed out about 10 minutes ago and started shaking. Patient started to wake up when EMS arrived."

Patient denies any other pain/Discomfort, nausea/Vomitting, no other complaints

------Initial Assessment---------------------------

GCS=E4,V5,M6(15) Pulse(Carotid Only)=132 Weak/Irregular

Automated Blood Pressure=Unreadable Manual Blood Pressure=UnReadable.

Respirations= 30/min and Shallow SPO2=94% RA

Lung Sounds=Clear BiLaterally

Skins= Cyanotic, Moist, Cool. Pupils= PERRL. Cap Refill= Below 2 Sec.

ECG=A-Fib w/o Ectopy 12-LEAD=Non-Stemi.

-----------------------------------------------------

Administered oxygen NRB, SPO2=94% NRB

IV 18G left AC NS Flowing

Positioned Patient Semi-Fowler's

 

Patient states- "Thanks guys your the best....PAUSES..... I think im getting worse"

 

At this point patients skin color from clavicle level up turns blue. Patient passess out and pupils dilate fully. Patient goes into PEA Arrest. At this time a newly presenting stiff mass has become visible at patients epigastric area. ACLS is started. ET-Tube is placed. Patient transported code3 to the hospital where rescusitation efforts are later stopped.

[ranchoemt]

ALS Ambulance and ALS Fire Engine arrive on scene at the same time to residence for a reported "Diff Breather". At front door is reporting party(patient's daughter) directing crew into the kitchen. Crew enters kitchen to find 57 year old male lying left lateral in mild to moderate distress. Patient is awake and tracking. Patient is able to answer questions and states "I had trouble breathing in, I passed out and went down to the floor. Its never happened before."

Daughter reports "He was playing racket ball earlier and has had a gradual onset of difficulty breathing since playing. Patient has no medical Hx, no allergies and no meds. 911 was called when patient passed out about 10 minutes ago and started shaking. Patient started to wake up when EMS arrived."

Patient denies any other pain/Discomfort, nausea/Vomitting, no other complaints

------Initial Assessment---------------------------

GCS=E4,V5,M6(15) Pulse(Carotid Only)=132 Weak/Irregular

Automated Blood Pressure=Unreadable Manual Blood Pressure=UnReadable.

Respirations= 30/min and Shallow SPO2=94% RA

Lung Sounds=Clear BiLaterally

Skins= Cyanotic, Moist, Cool. Pupils= PERRL. Cap Refill= Below 2 Sec.

ECG=A-Fib w/o Ectopy 12-LEAD=Non-Stemi.

-----------------------------------------------------

Administered oxygen NRB, SPO2=94% NRB

IV 18G left AC NS Flowing

Positioned Patient Semi-Fowler's

 

Patient states- "Thanks guys your the best....PAUSES..... I think im getting worse"

 

At this point patients skin color from clavicle level up turns blue. Patient passess out and pupils dilate fully. Patient goes into PEA Arrest. At this time a newly presenting stiff mass has become visible at patients epigastric area. ACLS is started. ET-Tube is placed. Patient transported code3 to the hospital where rescusitation efforts are later stopped.

[flyingsquirrel]

I second AAA/TAA. It's also a half decent story for tension pneumothorax or tension pneumomediastinum...or it could be a PE...PEs can be tricky.

If you were on the call, you can request follow-up info from the hospital and find out what the autopsy showed.

[flyingsquirrel]

I second AAA/TAA. It's also a half decent story for tension pneumothorax or tension pneumomediastinum...or it could be a PE...PEs can be tricky.

If you were on the call, you can request follow-up info from the hospital and find out what the autopsy showed.

[GeneValgene]

I second AAA/TAA.

 

what i was thinking too...curious what the autopsy showed

[GeneValgene]

I second AAA/TAA.

 

what i was thinking too...curious what the autopsy showed

[ranchoemt]

I also posted this call on EMTLIFE.com, the EMS community is leaning towards PE. I would like to hear why you guys suspect Aneurysm. **My gut feels a tearing sensation although my patient didn't, that is to say i suspect TAA/AAA **

 

http://www.emtlife.com/showthread.php?p=383857#post383857

[ranchoemt]

I also posted this call on EMTLIFE.com, the EMS community is leaning towards PE. I would like to hear why you guys suspect Aneurysm. **My gut feels a tearing sensation although my patient didn't, that is to say i suspect TAA/AAA **

 

http://www.emtlife.com/showthread.php?p=383857#post383857

[ranchoemt]

http://www.emtlife.com/showthread.php?p=383857#post383857

[ranchoemt]

http://www.emtlife.com/showthread.php?p=383857#post383857

[ranchoemt]

With whom do i ask about the follow up?

[ranchoemt]

With whom do i ask about the follow up?

[True Anomaly]

At this point patients skin color from clavicle level up turns blue. Patient passess out and pupils dilate fully. Patient goes into PEA Arrest. At this time a newly presenting stiff mass has become visible at patients epigastric area. ACLS is started. ET-Tube is placed. Patient transported code3 to the hospital where rescusitation efforts are later stopped.

 

Leads me more towards ruptured AAA or aortic dissection- the dissection could've ripped down to the aortic root

[True Anomaly]

At this point patients skin color from clavicle level up turns blue. Patient passess out and pupils dilate fully. Patient goes into PEA Arrest. At this time a newly presenting stiff mass has become visible at patients epigastric area. ACLS is started. ET-Tube is placed. Patient transported code3 to the hospital where rescusitation efforts are later stopped.

 

Leads me more towards ruptured AAA or aortic dissection- the dissection could've ripped down to the aortic root

[True Anomaly]

With whom do i ask about the follow up?

 

Generally with cases like this, the ED will inquire the medical examiner office for final results, provided that in the ED there wasn't something done quickly like a FAST to look for free fluid in the belly which would definitely point more towards rupture. One way to help with terminating efforts of resuscitation is to look for any cardiac activity on ultrasound, which would also give a gross idea as to what may have happened.

 

In short, ask the ED. There's likely to be people there who take enough active interest in it since it's an interesting case to know more of what happened.

[True Anomaly]

With whom do i ask about the follow up?

 

Generally with cases like this, the ED will inquire the medical examiner office for final results, provided that in the ED there wasn't something done quickly like a FAST to look for free fluid in the belly which would definitely point more towards rupture. One way to help with terminating efforts of resuscitation is to look for any cardiac activity on ultrasound, which would also give a gross idea as to what may have happened.

 

In short, ask the ED. There's likely to be people there who take enough active interest in it since it's an interesting case to know more of what happened.

[ventana]

gotta wonder about PE if it is not a AAA rupture

 

keep us updated

[ventana]

gotta wonder about PE if it is not a AAA rupture

 

keep us updated

[flyingsquirrel]

With whom do i ask about the follow up?

 

Some large hospitals have an EMS coordinator who can get you full access to discharge summaries, progress notes, and the like. If this person doesn't exist or isn't helpful, try tracking down the doc you transfered care to (best option) or the nurse manager of the ED. Don't let them pull any HIPPA BS and go thorugh your agency training coordinator if needed.

[flyingsquirrel]

With whom do i ask about the follow up?

 

Some large hospitals have an EMS coordinator who can get you full access to discharge summaries, progress notes, and the like. If this person doesn't exist or isn't helpful, try tracking down the doc you transfered care to (best option) or the nurse manager of the ED. Don't let them pull any HIPPA BS and go thorugh your agency training coordinator if needed.

[Just Steve]

Typically I chat up the ER doc who ran the code and they slip me the inside info once they get the word back from autopsy.

[Just Steve]

Typically I chat up the ER doc who ran the code and they slip me the inside info once they get the word back from autopsy.

[brookspa]

TAA/AAA . said my entry did not have enough letters. its still TAA/ AAA.

[brookspa]

TAA/AAA . said my entry did not have enough letters. its still TAA/ AAA.

[medic25]

Some large hospitals have an EMS coordinator who can get you full access to discharge summaries, progress notes, and the like. If this person doesn't exist or isn't helpful, try tracking down the doc you transfered care to (best option) or the nurse manager of the ED. Don't let them pull any HIPPA BS and go thorugh your agency training coordinator if needed.

 

As the hospital EMS coordinator, providing follow-up to field providers is a big part of my job description. I spent a good part of the day today sending cath lab reports and images back to medics who brought in field cath lab activations (including a 9 minute D2B!). Feedback to our crews is an essential part of the EMS system; I would check with your medical director about how best to get this kind of info.