First of all, Happy New Year to everybody!!!
I've a case up for discussion. You're on shift and an Advanced Paramedic
puts this strip in front of you (attached, also at
http://www.iemta.ie/imgdump/strip.jpg )
The story is that of a 75 year old male, standing at fence talking to his
neighbour when he goes unresponsive and slowly sinks to the ground. Over
the next 20 minutes his GCS drops to 5/15. When the APs arrive the HR is 49
and BP reading about 55/palp. Turns out the gentleman has a parenchymal
intracerebral haemorrhage.
But anyway, there are 2 APs on-scene debating whether to give the patient
atropine for a symptomatic bradycardia. According to their current clinical
practice guidelines (Irish guidelines available at
http://www.phecit.ie/Documents/Clinical%20Practice%20Guidelines/CPG-
A/CPG-Advanced%20Paramedic.pdf refer to CPG-A8 page 10 Adult
Symptomatic Bradycardia), atropine can only be given for HR<50 and if 2nd
degree type II, and third degree AV block have both been excluded (plus
patient symptomatic)
The AP in question has come to you saying "What should I do the next time?"
There are some areas where P-waves are visible and it appears like a
complete AV block but other areas I'm not so sure. A number of us have tried
to trash this out but have yet to come to a consensus, so I'm opening it to
the list.....
Jason Horan
SpR Emergency Medicine
Limerick, Ireland
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