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Symptomatic Ventricular TachycardiaScenario InformationTitle:Symptomatic Tachycardia – Rate Related Chest PainDate Created:23 December 2015Target Audience: FORMCHECKBOX PCP I FORMCHECKBOX PCP II FORMCHECKBOX PCP FORMCHECKBOX ACP FORMCHECKBOX CCPScenario Author:Will JohnstonAuthor Contact:C_johnston37@fanshaweonline.caScenario OverviewParamedics are called to a 55 year old Male complaining of Chest Pain and severe weakness, dizziness, and lightheadedness. Paramedics will find the patient in a wide-complex Tachycardia with a pulse. Patient will go into pulseless VT during the scenario requiring 1 shock to successfully convert the patient into a perfusing rhythm. Patient should then be transported with peripheral IV cannulation en route.Scenario Objectives, Summary, NOCPS, and ExpectationsLearning Objectives:Understand and employ the appropriate treatment steps for a patient in unstable ventricular tachycardia Recall situations where load and go is an appropriate responseAppropriately employ proper post cardiac arrest careAssociated NOCPs 4.3c – conduct cardiovascular assessment and interpret findings4.5m – conduct 3-lead electrocardiogram (ECG) and interpret findings5.5a – conduct cardiopulmonary resuscitation (CPR_5.5d – conduct peripheral IV cannulation 5.5j – conduct manual external defibrillation Paramedic GRS1 Expectations:Situational Awareness: recognize that the patient is in an unstable conditionHistory Gathering: develop a treatment plan based on a thorough history of patient condition and medical historyPatient Assessment: make a diagnosis based off of the 3 lead and patient conditionDecision Making: rapidly load patient and do not treat as cardiac chest painResource Utilization Communication: communicate effectively with the patient Procedural Skill: good lifting for patient extrication Tavares W, Boet S, Theriault R, Mallette T, Eva KW. Global rating scale for the assessment of paramedic clinical competence. Prehospital emergency care. 2012 Dec 5;17(1):57-67.Scenario PreparationPatient RequirementsMoulagePatient InstructionsSpray to make patient diaphoretic (water)Makeup to make patient pale Patient was getting agitated while watching a hockey game on TV prior to episode occuringPatient is feeling extremely light headed and dizzy and like heart was racing. This has been happening off and on for a number of days now, never this sustained. Patient should ask if Paramedics think he is going to “be ok”Patient should complain of the light headed feeling getting worse over the course of the scenarioAdditional Equipment and PropsPropsEquipment ChairTV Tray/ Coffee TableFood and Beer (sitting on table)TV or computer monitor Monitor Defibrillator with a rhythm generatorBLS Bag including symptom reliefStretcher Oxygen bagPatch phone (for hospital patch) Scene Set-UpPatient should be sitting in the on the chairTV tray is set up with food and/or beer sitting on the chair Bystander No Bystander for this scenario Dispatch Information Unit please respond for a 55 year old Male. Complaints of Chest Pain, lightheadedness, and dizziness. Negative for travel.Patient Information Patient Name: Clark VennarAge: 55Weight: 90kgsGender: MaleChief Complaint: Lightheaded and Dizzy. Feels like heart is racingHistory of Present: Symptoms began ~25 minutes ago. Patient noticed became extremely dizzy when standing. Episode was going on for significantly longer than previous episodes prompting activation of paramedics. SAMPLE History: AllergiesNoneMedicationsMetoprolol, Simvastatin, Metformin, Diltiazem, ASA, Nitro, LasixPast HistoryHTN, High Cholesterol, NIIDMOral IntakeFood on the table and 2 beers ~45 minutes prior to arrivalOPRST (If Applicable) OnsetSitting watching the gameProvocationNonePalliationNoneQuality“Feels like my heart is racing” Radiation None Severity 10/10Time~25 minutesAdditional InformationBefore the patient becomes VSA, should state “I feel like I’m going out” Physical FindingsPrimary Survey:AirwayPatentBreathingSlightly LabouredCirculationVery rapid central pulsesAuscultation Clear and Equal with no Adventitious SoundsDistal PulsesVery weak peripheral pulsesShockPale, cool, sweatySecondary Survey :Head Unremarkable NeckUnremarkableChestUnremarkableBackUnremarkablePelvisUnremarkableLegsUnremarkableExtremitiesUnremarkableVital Signs, Expected Actions, and ModifiersPatient states change throughout the scenarios. Generally a scenario will include 3 patient states. You may have more than 3 patient states if you have a very dynamic scenario or if there are a number of potential patient modifiers. Patient State 1:State: BaselineTRIGGER: Start of Scenario Vital Signs Expected ActionsHR 180Quick application of cardiac monitorEarly vital signsRapid administration of oxygenRapid initiation of transport SPO289BP80/60CO240Temp36.9SkinPale, cool, DiaphoreticGCS15Pupils3 + + BGL5.6ECGV-Tach12 LeadVentriuclar TachycardiaModifiers If patient is given Nitroglycerine, immediately proceed to Cardiac ArrestTrigger 5:00 OR Administration of NitroglycerinePatient State 2: State: VSATRIGGER: 5:00 OR Administration of Nitroglycerine Vital Signs Expected ActionsHR0Pads placed in the proper positionManual Defibrillation at 200JCPR with proper hand positioning If in ambulance, ask partner to stop driving and return to the back to help SPO20BP0CO212Temp0SkinPale, cool, Diaphoretic GCS3Pupils3 - - BGL0ECGV-Tach12 LeadVentricular TachycardiaModifiers Patient will not rouse if 1st shock is delayed by longer than 1:00 minuteTrigger 1st Shock is Delivered: (1:00 – Patient State 3) (>1:00 – Patient State 4)Patient State 3: Post ArrestState: Post ArrestTRIGGER: Defibrillation within 1:00 Vital Signs Expected ActionsHR80Blood pressure takenIV initiatedFluid bolus as per local protocols Good patch to hospitallSPO295BP80/40CO240Temp36.7SkinPale, cool, diaphoreticGCS15Pupils3 + + BGL5.6ECGNormal Sinus with PVCs12 LeadNSR with PVCsModifiers noneTrigger 12 minutes (Scenario END)Patient State 4: (If Necessary)State: VSATRIGGER: Defibrillation takes longer than 1:00 Vital Signs Expected ActionsHR Defibrillation with increases according to local protocolsPlacement of a King LT or OPA as per protocolsHigh quality CPR SPO2BPCO2 TempSkinGCSPupilsBGLECG12 LeadModifiers NoneTrigger 12 Minutes (Scenario End) ................
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