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00:00 This is a very different type of a twist on a presentation in that you know, we look at doing base presentations. We're looking at chest pain and use soccer player. I think there's a unique case that was that came out in a journal not a couple here. 03:14 You'll get the vote on your phone or if you pull up a separate screen next to this, you'll be able to use a similar similar screen that you'll see interactive what how people are voting. When we get that vote in, take a couple seconds, and then we will make that we'll we'll go off that decision. 06:54 The patient is a 16-year-old otherwise healthy male soccer employer. They denied alcohol use cocaine drug use, reported marijuana use 3 weeks prior. And they all the patient also admitted to taking vyvanse till at 5 AM on the day of this event. 10:44 What's your first action step? And, again, what what the audience picks here is where we were going to go with this, the most plausible next step. If you're on and you're able to, please do try to vote. Helps in in the overall responses here. 16:32 Gave info and and also gave info about alcohol, vitamins, and the other drug use. So we've gotten a good pain a picture of what this looks like. Now let's look into interventions. We're gonna have 2 interventions you'll choose from in this next couple of steps. 21:52 You're making the decision to read the earlier was 26. SPO 2 was 20 I mean, it was 93. Now continue to have school diaphritic cool, clammy skin, and the SPO2 has now dropped to 89. Now that you reassess vitals, patient now has altered mental status. They now have a GCS. Of 12. Heart rate heart rate is now at 200. 26:40 The athlete was kicked in the chest with a soccer ball, a kick. He went down, did not have any loss of consciousness, had some chest pain. After 2 minutes, they got up and played again. And then now they throughout the day, when you saw the pavement, when he was in the stands, you're saying that he felt okay during the day. He then also had or he felt like his heart was jumping, at that point in time earlier, and then now is having the case. 30:48 In this actual case, The athlete reported 8 hours later, so it's kind of a similar time frame, but reported to the emergency room and was having 170 to 200 on the heart rate. And the difference is ventricular flutter is a it can be lethal. It's a precursor to ventricular fibrillation. 34:29 I also had an echocardiogram, had normal ventricular site, systolic function, no other issues, no pericardial effusion, but we would think in terms of like a cardiac tamponade, were regional wall motion abnormalities. Less than 30 cases reported annually. 38:42 The first thing you want to do is assess the patient's condition. Do quick rapid assessment. What their level of consciousness is, checking, you know, those couple of things as well. If you notice having difficulty breathing, you wanna try to control that with and how to do oxygen administration. 42:18 Whether it's written down or a full script down or an algorithm, this has to be clear to particularly these various steps encouraging definitely look at the new 2020 2020 guidelines. Make does your protocol address this? This is the best best practice in terms of whether you're doing, you know, repeating CPR, go through the shockable rhythm. 45:52 The first set's gonna be running every 5 minutes. You keep running through unless they're stable and they're not regressing, then you could probably extend that to 10 minutes if you need to. Tell them what the what's relevant. Put everything on the table that's really relevant, and this does it. 49:31 Doctor Harper: It's about 30 30 cases a year, typically. So we're not seeing this very often. This was the first one I've seen where there was actually a delayed case where they attributed it may have been those documents is coming to court. 53:12 It's just really it's one of the simplest and best devices there is to help determine clinical trajectory in what you do in those next steps. What are your rules say, what is your device? What is your medical direction directed you to say? That's really the the the key point is technology can do a lot of things, but you have to have your guidelines and your protocol set up. 56:49 Athlete got hitting the chest really hard. He began to decompensate. It took a little while, but by the time he came to the athletic trainer, he was he was not feeling good at all. 1:00:27 When somebody is still technically, mechanically breathing, when you start trying to control their breath by putting air into them with a back valve mask does not come as a natural skill for athletic trainers. It is not taught in a CPR class, but it definitely needs to be part of your protocol. 1:04:24 I think just as if you understand how to the communication is so incredible to any situation, and it is if if People know what they're doing. I like to say, like, stay in your lane and and teaches people how to do that. But also prevents people from it it we're not having the process of practicing EAP depending on your setting. 1:07:55 This is a fifteen year old athlete come had a main complaint of it getting hit in the chest as the incident occurred. Know the history of injury, whether whether vinyls. This is what they occur at. And then, okay. Now it's time to hand off. 1:11:07 I think this the the point of continual practice, like working on how to hand off not practice, not only the skill itself, but those that type of that Nuance situation where you're not really sure where to do this or you do it. At the tail end of this, you have EMS coming on-site. You are still part of that process. Continue taking vitals. 1:15:01 An interesting question about when to put the AED on and let me ramble for just a minute. As an instructor, you know, we teach people unresponsive and not breathing, apply the Aed, and then let it let it do its job. And then you've got Doctor. Dresner's new video, what sudden cardiac arrest looks like, and eyes rolled back to their head. 1:19:05 Is He could have tried a basal vehicle technique to bring that heart rate down because it is proven. Another one is actually, if you've catch your ice immersion there, have them put their face down, which sounds counterproductive into that water. 1:23:02 I mean, try when you're thinking about that, just work through the process is how to excuse me. A lot of it is just to be tabletop exercises. We know what that looks like as well. But having different forms, even doing a case study is an example. This helps in just kind of treating the the brain is an exercise or doing as an exercise point.
