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357Re: [E-Chir] Scenario 4

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  • Kathleen Gormanshaw
    Dec 21, 2009
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      Well, there's a text book heart attack set-up, at least for a man.  Women don't usually get the arm pain:  "Surprisingly, fewer than 30% reported having chest pain or discomfort prior to their heart attacks, and 43% reported have no chest pain during any phase of the attack." From:  http://usgovinfo.about.com/cs/healthmedical/a/womensami.htm  It doesn't mention whether women are as likely to deny an attack as men or not.
      So I have a patient who alarms me but doesn't want me to fuss over her.  The next steps will depend a lot on how well I know her, and what I know about her.  Unless I think I can change her mind very quickly, I'm going to quietly whisper in the autocrat's ear to go call an ambulance, discretely.  I hope the ambulance guys have better expertise on convincing her to go to the hospital.  (I should probably just whisper to the autocrat anyways.)
      How to change her mind?  I might talk about how active she was last time I saw her, and that this is reallly NOT like her, something must be wrong.  Or maybe how her breathlessness reminds me of my asthma attacks, and those are scary, but medications really help fast.  Or maybe appeal to her sense of family, and how much they'd worry if something happened to her, she should get checked out to make sure they don't worry.

      On Mon, Dec 21, 2009 at 1:40 PM, Ninka <dyscordant_rose@...> wrote:

      (Just in case you find some time between all those dinners and have a couple of brain cells that you wish to rub together during this holiday season...here's another scenario for you) :D
      You arrive at your local event shortly before the gate opens and are just trying to get you and your gear through the door when you are met by the autocrat of the event who asks if you'd be willing to take a look at Mary. The atutocrat tells you that Mary was part of the set-up group who arrived about an hour and a half ago. They'd all been working pretty hard getting chair and tables moved, hauling boxes in for the bar, hauling stuff in for the kitchen and whatever else has needed to be done before the gate opens. The autocrat tells you that she's been a bit worried about Mary, who didn't seem all that well when she got to the site earlier and now seems to be slowing down; needing to sit more often.
      You find your kit in amongst your gear and follow the autocrat to where Mary is currently sitting in a chair in the hallway outside the kitchen. You recognize Mary as one of your older members..you seem to recall that she had had her 50th birthday a couple of months back. Mary appears to be having some mild breathing distress. She appears pale and sweaty. When she sees you coming she shakes her head and tells you that she doesn't know what all the bother is; she is just winded from all the work due to the fact that she thinks she's been coming down with a cold or something which started last night. You notice that she can't seem to speak more than 5-6 words without having to take a breath.
      When you attempt to question her further you do discover that she is a bit nauseated (though she hasn't thrown up yet) which she attributes to coming down with something. You notice that every so often she reaches over to rub her left shoulder. When you question her about that she tells you that it doesn't hurt though it does ache but she states that its just from carrying boxes that she probably should've let younger good looking men carry rather than an old lady like herself. Other than a bit of dizziness now and then today Mary won't admit to feeling anything else and continues to claim that she is just feeling under the weather.

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