Working on the weekend in our resus area, we received a Priority Call from the ambo's bringing in a 61 male, central chest pain, diaphoretic, in peripheral shutdown, no palpable blood pressure or radial pulse, but pulse of 60bpm on there monitor ETA: 5 mins.
So i began to prepare for there arrival thinking this guy's in a perri arrest situation, got all the monitors ready, drugs drawn up, team all standing there waiting, in anticipation
Patients arrives;
Hx from ambo's
61 male
1/24 hx of Central Chest Pain 8/10, sweating, mild tachypnea,
Non Palpable BP or radial pulse, cold peripheries.
Monitor show pulse 60bpm, ? st elevation
Gave aspirin, no gtn as ? no BP
So i attach this patient to our monitor, whilst the dr starts with the Hx.
Monitor show Pulse 64bpm, Spo2 99% on 15l O2, BP 124/76, Resps of 24.
12 lead ecg shows some st depression.
Patient still c/o chest pain 8/10, dr orders x2 sprays of gtn,
Patient also gets 5mg Morphine IV, pain now 1/10.
Thinking this patients in shock, because of the peripheral shutdown, and non palpable radial pulse the dr orders 500mls saline stat.
Whilst doing my assessment on the patient i noticed the ambos were right, i could not palpate a radial pulse and the patients hands were freezing.
The patient now that he is pain free and feeling better, although he's still having a MI, decides to tell us his hands are normally cold because he suffers from Raynaud's Phenomenon. This then explains the symptoms of difficulty finding peripheral pulses, and his cold, poorly perfused hands and feet.
The patient remained stable in ED, admitted by cardiology, went to CCU, and was booked for an angiogram that afternoon.
Raynaud's Phenomenon:
What is it:
Signs & Symptoms:
Management:
So i began to prepare for there arrival thinking this guy's in a perri arrest situation, got all the monitors ready, drugs drawn up, team all standing there waiting, in anticipation
Patients arrives;
Hx from ambo's
61 male
1/24 hx of Central Chest Pain 8/10, sweating, mild tachypnea,
Non Palpable BP or radial pulse, cold peripheries.
Monitor show pulse 60bpm, ? st elevation
Gave aspirin, no gtn as ? no BP
So i attach this patient to our monitor, whilst the dr starts with the Hx.
Monitor show Pulse 64bpm, Spo2 99% on 15l O2, BP 124/76, Resps of 24.
12 lead ecg shows some st depression.
Patient still c/o chest pain 8/10, dr orders x2 sprays of gtn,
Patient also gets 5mg Morphine IV, pain now 1/10.
Thinking this patients in shock, because of the peripheral shutdown, and non palpable radial pulse the dr orders 500mls saline stat.
Whilst doing my assessment on the patient i noticed the ambos were right, i could not palpate a radial pulse and the patients hands were freezing.
The patient now that he is pain free and feeling better, although he's still having a MI, decides to tell us his hands are normally cold because he suffers from Raynaud's Phenomenon. This then explains the symptoms of difficulty finding peripheral pulses, and his cold, poorly perfused hands and feet.
The patient remained stable in ED, admitted by cardiology, went to CCU, and was booked for an angiogram that afternoon.
Raynaud's Phenomenon:
What is it:
- Described as episodic vasospasm of the peripheral arteries causing pallor, cyanosis and redness, with pain and sometime parathesia, and , rarely ulceration or gangrene.
- Attacks typically occur after exposure to cold or stressful situations.
- Attacks primary affect fingers and hands.
Signs & Symptoms:
- The Affected part of the body first turns white (Pallor), as the small blood vessels constrict, then bluish (cyanosis), as oxygen in the blood in the now narrowed blood vessels become exhausted and finally red, as the blood vessels are dilated and blood flow returns to the area.
- Pain and parathesia can occur during the attack.
Management:
- Emergency treatment of this conditions consists of symptomatic relief, providing analgesia, and immersion in warm water sometimes helps.
- D/C for f/u with GP or specialist, pt sometime prescibed Calcium channel blockers or Alpha-blockers which work on the smooth muscle to relax the small blood vessels
Reference:
Summers, A. (2005). From White to Blue to Red: Raynaud's Phenomenon. Emergency Nurse, 13(7), 18-21.
