asked 1 year ago
Hello, I had an interesting call over the weekend where we were dispatched for a fall code three.
On arrival in the hallway of this apartment was a rather small lady, vomiting c/o dizziness and nausea. Apparently she went to the bathroom, felt dizzy, collapsed and called for help. Got a quick sugar and palpated a Brady pulse and I just opted to get the pt extricated giving the small quarters and little room. Pt was collared and cleaned up and we got out as quicky as we could. When we loaded her, pt started vomiting which we managed and pt discovered to have an inferior STEMI w HR at 33bpm. The B/P was low 90s, confirmed manually. I gave fluids, activated STEMI alert, and began transport.
What's bothering me, is the opportunity to pace or not with an inferior STEMI but the B/P was slightly above 90. I spoke to the doc in the ER and he stated it was probably better to just give the fluids and get her here like we did. Pt was a/o x 3 and she remained with eyes closed and throughout call when asked any question she would open her eyes and answer well.
1 Answers
answered 1 year ago
Thank you for the question.
One of the more common side effects of an inferior MI is bradycardia. Remember bradycardia is just a number, the key thing is if the patient is perfusing which is usually quantified by blood pressure. We accept a mean arterial pressure of 65 or a systolic BP of 90 if the patient is showing signs of good end organ perfusion-mentation, strong pulses etc.
If not then administration of atropine or TCP is required. The nice thing about inferior MIs is that they are usually vagal mediated and so they respond to atropine. In this case, although the patient had a HR of 33, her SBP was in the 90s so was not in immediate need of pacing but you can argue that she did fall and hence is not well perfused. So I think a dose of atropine could be considered or a BHP patch to discuss atropine if unsure.
If not then administration of atropine or TCP is required. The nice thing about inferior MIs is that they are usually vagal mediated and so they respond to atropine. In this case, although the patient had a HR of 33, her SBP was in the 90s so was not in immediate need of pacing but you can argue that she did fall and hence is not well perfused. So I think a dose of atropine could be considered or a BHP patch to discuss atropine if unsure.
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