Test Question

[Guest guest]

Sir:

It is impossible to give any pat answer to any emergency medical

scenario without some qualifications, but this one seems fairly clear.

You describe a patient with mild chest pain, which could be MI-related

or related to the poor cardiac output from the heart rate. This is an

excellent example of why paramedics should be using 12-Lead ECG.

In this case, were the ECG to indicate no evidence of myocardial

infarct, I would assume the PVCs were escape beats and I would treat

with atropine to raise the rate. I would try for a rate of between 60

and 70. Only if the increased rate did not resolve the PVCs would I

consider lidocaine.

If the ECG suggested an MI, I would still be reluctant to use lidocaine,

given the hypotension and slow rate. In this instance I would observe

the patient under 100% oxygen for a short period. If hyperoxygenation

failed to produce any improvement, I would still reach for the atropine

first, however I would give the minimum effective dose. One has to be

careful here because too low a dose of atropine can actually slow the

heart further.

The reason for the caution in the latter case is the concern for

extending a developing MI vs. the concern for adverse outcomes from the

continued low BP and electrical instablility of the heart.

That is what I would teach my 2nd-semester paramedic students.

Have you alternative thoughts? I'd like to here what your ideas are.

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