CASE STUDY PH5-1
You have been dispatched to an unknown type call. Upon arrival, you find a 24-year-old female office worker sitting down, in no apparent distress. She advises you that she has had 2 episodes of “pounding” in her chest this morning. She had 911 called when she believed the episode “lasted too long”. She is still experiencing the palpitations. Her BP = 108/68; pulse = 166 (strong and regular); her respiratory frequency = 12/minute. You place her on the ECG monitor and see the following:
She denies other medical history except for these infrequent “pounding” episodes that begun when she was in junior high school. You establish an antecubital IV. You attempt several vagal maneuvers without success. You then administer adenosine 6 mg rapid IV push followed by a 30 ml bolus of IV fluid. The patient complains of an intense, momentary “thump” in her chest. The ECG rhythm is unchanged. You administer a second bolus of adenosine at 12 mg rapid IV push, again, followed by the 30 ml IV fluid bolus. The patient makes a loud gasping sound and you see the following on the ECG monitor:
The patient informs you that “it’s gone”. She is comfortable and stable. You transport her to the emergency department.
CASE STUDY PH5-2
You are called to the residence of a 56-year-old female complaining of shortness of breath. Upon your arrival, she appears somewhat anxious, and states that her “heart is racing”. You start her on low-flow oxygen and place her on the ECG monitor. Her BP = 132/74; P = 166/minute; and, her respiratory frequency = 27/minute. This is what you see on the ECG monitor:
You establish IV access, and administer verapamil 1 mg/minute. She receives 6 mg totally over six minutes when you notice that her arrhythmia has converted back to a sinus rhythm.
She states that she does not feel short of breath or any palpitations now. Her BP = 120/70; pulse = 70/minute. You transport her to the emergency department.