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My Stomach hurts!

by on May 3, 2011

EMS arrived on scene to find a 65-year-old female sitting in a chair inside an office. She stated she was walking around when she began to have upper abdominal pain. She stated it is a sharp ache but does not radiate. Pain is non-reproducible on palpation and abdomen is soft and tender. She appeared pale and clammy. She had one episode of emesis prior to EMS arrival and is still nauseated. She tells EMS, when questioned that she has had one previous MI about 8 yrs ago and this feels similar. Crew moved pt to the stretcher and placed her on 02 and laid her back at a 45 degree angle moved to the ambulance and transported to a local ER 22 minute ETA.

BP 90/50
RR 18
SP02 98%

12 Lead

what other treatment en route do you wish to give?

From → Case File

  1. J. Forsyth permalink

    Cp Protocol, take her anywhere but Baptist. haha… Bilateral Large Bores. Maybe even get her some Fluid Bolus though. HF pads for sure. Call that Inferior with reciprocal changes starting in lead I STEMI… Definitely hope she likes CATH labs.

  2. Shahzad Akhter permalink

    This is Acute Inferior Wall MI. I would record Right sided Chest Leads to rule out RV Infarct and give her ACS Protocol. I would give her Tab Aspirin, Tab Clopidogrel and sublingual Nitroglycerine, establish IV line and give Heparin 5000 units stat along with Inj Maxolon, Inj Zantac and IV Morphine. If the chest is clear, I would give her IV bolus and call the hospital ahead to prepare for primary PCi.

  3. @Forsyth, Baptist ER, In our part of the world, is definitely not an appropriate choice for this patient.

    • Anonymous permalink

      Oh for sure I should’ve said Bapt or Prov NE seeing as how they’re the only two that don’t have cath labs! Well not interventional caths anyways! Just out of curiosity what exactly does Zantac do for a STEMI pt? Not being a smarta$$ just wondering?

  4. Plavix danger in combination with proton pump inhibitors
    Plavix, also known as clopidogrel and sold by Sanofi and Bristol-Myers Squibb, is widely used with proton pump inhibitors, or PPIs, including AstraZeneca’s Nexium and Prilosec to cut the risk of gastric problems.
    In one study, patients with stents who take Plavix with prescription heartburn drugs, including AstraZeneca PLC’s Nexium, are significantly more likely to be hospitalized for a heart attack, stroke, chest pain or a coronary artery bypass operation than those who take Plavix alone.
    Heartburn pills like Nexium and Prilosec stop blood-thinning drugs such as Plavix from working effectively.
    The Food and Drug Administration said in November 2009 the stomach-soothing drugs Prilosec and Nexium cut in half the blood-thinning effect of Plavix, known generically as clopidogrel. Regulators said the key ingredient in the heartburn medications blocks an enzyme the body needs to break down Plavix, muting the drug’s full effect. Procter & Gamble’s Prilosec OTC is available over-the-counter, while AstraZeneca’s Nexium is only available with a prescription. The FDA says patients who need to reduce their acid should take drugs from the H-2 blocker family, which include Johnson & Johnson’s Mylanta and Boehringer Ingelheim’s Zantac. FDA scientists say there is no evidence those drugs interfere with Plavix’s blood clotting.

  5. Toyanna Frye permalink

    This is an inferior all day long, with changes with depression and t-wave inversion in aVL and I. ASA for sure. I would stay away from nitro and morphine en route to the ER/ Cath Lab however considering her blood pressure. IV, high-flow O2, high-flow diesel…

  6. @toyanna, Don’t be afraid to give NTG with this patient after you obtain an IV. You can do a quick V4R to rule out RVI. If RVI was found you would give a bolus prior to administering NTG.

    If you are thinking about AAA
    Most abdominal aortic aneurysms (AAAs) develop slowly over years. They often don’t cause signs or symptoms unless they rupture. If there is an AAA, you may feel a throbbing mass while checking the abdomen.

    When symptoms are present, they can include:

    A throbbing, tearing, or ripping feeling in the abdomen
    Deep pain in your back or the side of your abdomen
    Steady, gnawing pain in your abdomen that lasts for hours or days

  7. permalink

    No morphine or NTG due to Low B/P, ASA high flow O2, and high flow diesel. Med control.( LAD )Go T Frye

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