Pacing Vs. Airway Management

[MARK FORREST]

Hi Gavin,
-Secure the airway with a tube or at the very least with a supra-glottic airway and commence ventilation with 100 % oxygen (collapse could be related to hypoxia or respiratory insfuffciency, so this alone may help to a degree)
-if no improvment in rate or rhythm then go for ext pacing (consider an anticholinergic whilst getting the kit if necessary)
-then transport
Cheers
Mark
UK
 



----- Original Message ----
From: Gavin SUTTON <Gsutton at pgwc.gov.za>
To: trauma-list at trauma.org
Sent: Friday, 16 May, 2008 10:22:26 PM
Subject: Pacing Vs. Airway Management

Just a question if I may... 

Pre-hospital case, 55 year-old male patient with Hx of IHD and hypertension. He is on pharmapress and Isordil. He has defaulted for 6 months. His EKG shows a sinus rhythm of 110 with ischemia. While the paramedics are treating the patient, he becomes unresponsive, the ECG shows 3rd degree HB and he has a BP of 80 systolic. He has very poor tidal volume.

What would you do?

1. Begin external pacing immediately
2. Sort out the patient's airway first (intubation) and ventilate with a bag-valve-mask resuscitator - 100% O2, and then begin external pacing if no improvement
3. Transport to hospital while maintaining basic airway techniques and ventilation- 45 minutes away

Many thanks

Gavin 

Gavin Sutton
Head: Department of Training
Emergency Medical Services
Western Cape Department of Health
South Africa

Tel. +27 21 938-4118
Fax.+27 21 938-4269

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