I had a call today that prompted an indepth discussion with my Lt. He is a paramedic with almost 20 years experience. I am a paramedic with about 10 years experience. I would like to hear your thoughts and recommendations on this.
Here goes: The patient called with complaint of chest pain and SOB. Upon arrival, the patient was an elderly male and was found sitting in a chair. The patient was obviously pale and c/o left, lower, lateral chest pain and shortness of breath which started at 2 a.m.. The patient had been treated with NTG patch by his family w/o relief. Inital v/s indicated the patient with adequate B/P of 124 systolic, pulse 175 and weak, O2 sat - 84%, respirations of 22 and shallow. History of CHF and CABG. EKG revealed PSVT. Initial attempts to have patient "bear down" proved ineffective. O2 admin via NRB @ 15 lpm. IVNS established in R AC w/18 ga cath. I administered adenosine 6 mg RIVP followed by rapid bolus of NS, w/o results. I followed with 2 more doses of adenosine 12 mg RIVP w/o results. I then prepped pt w/2.5 mg versed, then sync cardioverted @ 100 joules and the patient converted to A-fib @ 80-100 bpm. Transprt code 3. B/P began to fall to 80/40 prior to arrival at ER.
Here's the question: What other treatments could have been done to this patient besides drug therapy or cardioversion? My Lt suggested a cold rag to the patient's face, in lieu of cold water immersion. I couldn't use carotid massage due to possible bruits.
Does anyone have any other less invasive treatments I might try in the future?
Please let me know what you think.