Paramedicine

This document discusses the initial clinical approach and abnormalities on the 12 lead ECG report of a patient with acute pulmonary oedema. It explains the pathophysiology of APO due to congestive cardiac failure and provides information on the Ambulance Victoria Clinical Practice Guidelines for treatment.

Running head: PARAMEDICINE
PARAMEDICINE
Name of the student:
Name of the university:
Author note:

1PARAMEDICINE
Initial clinical approach:
According to the case study, the patient needs the following
 Diuretics are the support which can be used to management patients for removal of
fluid from the lungs and heart as she has been facing mid zone crackles on
auscultation (Ellison & Felker, 2017).
 Oxygen therapy needs to be provided to the patient to make her breathing easier as
she has been witnessing shortness of breath (Sepehrvand & Ezekowitz, 2016).
 Morphine can be administered to the patient to relieve the shortness of breath and
uneasiness (Lisboa, Silva & Lisboa, 2016).
 Blood pressure medications needs to be provided to restore the pulmonary oedema in
the patient (Dunham-Snary et al., 2017).
 Nitro-glycerine should be used as it helps to decrease the pressure that is going into
the patient’s heart. The medication should be administered as she has cardiac
blockage issue in her heart and pressure to the heart may increase further
complications (Ellingsrud & Agewall, 2016).
Abnormalities on the 12 lead:
After the systematic interpretation of the ECG Report of the patient it was found that
the 12 leads of the ECG report of the patient shows low voltage QRS complexes with
Tachyarrhythmia which indicates irregular fast beats, also she has atrial flutter in the long
lead II along with Mobitz II heart block with states intermittently non conducted P waves.
The thin QRS complex tachycardia with QRS period of < 120 ms and the
rate > 100 bpm which indicates a condition of supraventricular origin with occurrence of
ventricular activation through the fast-conducting of His-Purkinje system (Brady et al., 2017).

2PARAMEDICINE
The heart rhythm of the patient is found slow/fast, slow rhythm is called bradycardia
and fast rhythm is called tachycardia.
The pathophysiology of how APO occurs due to congestive cardiac failure:
Acute Pulmonary oedema is frequently caused by cognitive cardiac failure. It occurs
when the heart loses its ability to pump in the appropriate manner so the blood returns back
into the veins which takes the blood via lungs. As there forms a situation of increase of the
blood pressure, the fluid gets pushed into the alveoli of the lungs (Picano & Pellikka, 2016).
The fluid composition in the alveoli reduces the normal oxygen transfer through lungs. The
association of these two conditions causes the problem of shortness of breath in a patient.
The symptoms of APO due to cognitive cardiac failure are wheezing for breath, suffocation,
sense of apprehension, rapid or irregular palpitation (Platz et al., 2015).
Ambulance Victoria Clinical Practice Guidelines (CPG) you would use to treat this
patient:
According to the CPG, Nitrates can be used to treat the cardiogenic APO and should
be provided to the patient with cardiogenic APO if contraindicated. Also, CPAP is one of the
essential treatment for patient with respiratory failure which is associated with APO. It is also
important that if the patient is unresponsive to nitrates administration, or the respiratory
failure is critical enough where it will require instant treatment simultaneous with nitrates.
Nitrates and CPAP should be initially provided to the patient and once the hypertension issue
is controlled with nitrates, Furosemide can be used for APO (CPG, 2019).

3PARAMEDICINE
Figure: Guidelines to asses a patient with Acute Pulmonary Oedema
Source: (CPG, 2019)
status: acute pulmonary oedema
crackles and breathing shortness;
provide oxygen therapy, diuretics, nitrates.
no onserved improvemnt; provide with CPAP, suction and
ventilation for clearing the blockage in the lungs.
incubation according to CPG A0302 Endotracheal Intubation
assess if hypertension resolved,
adminstre with Furosemide

4PARAMEDICINE
References:
Brady, W. J., Mattu, A., Tabas, J., & Ferguson, J. D. (2017). The differential diagnosis of
wide QRS complex tachycardia. The American journal of emergency medicine,
35(10), 1525-1529.
CPG, (2019). Retrieved
from :https://www.ambulance.vic.gov.au/wpcontent/uploads/2019/03/Clinical-
Practice-Guidelines-2018-Edition-1.8.pdf
Dunham-Snary, K. J., Wu, D., Sykes, E. A., Thakrar, A., Parlow, L. R., Mewburn, J. D., ... &
Archer, S. L. (2017). Hypoxic pulmonary vasoconstriction: from molecular
mechanisms to medicine. Chest, 151(1), 181-192.
Ellingsrud, C., & Agewall, S. (2016). Morphine in the treatment of acute pulmonary oedema
—why?. International journal of cardiology, 202, 870-873.
Ellison, D. H., & Felker, G. M. (2017). Diuretic treatment in heart failure. New England
Journal of Medicine, 377(20), 1964-1975.
Lisboa, E. P. E., Silva, J. P., & Lisboa, E. P. E. (2016). Blinded Patient Preference of
Morphine Compared to Placebo in the Setting of Chronic Refractory Breathlessness–
An Exploratory Study.
Picano, E., & Pellikka, P. A. (2016). Ultrasound of extravascular lung water: a new standard
for pulmonary congestion. European heart journal, 37(27), 2097-2104.
Platz, E., Jhund, P. S., Campbell, R. T., & McMurray, J. J. (2015). Assessment and
prevalence of pulmonary oedema in contemporary acute heart failure trials: a
systematic review. European journal of heart failure, 17(9), 906-916.

5PARAMEDICINE
Sepehrvand, N., & Ezekowitz, J. A. (2016). Oxygen therapy in patients with acute heart
failure: friend or foe?. JACC: Heart Failure, 4(10), 783-790.