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358Re: [E-Chir] Scenario 4

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  • Bethoc (Lesley)
    Dec 21, 2009
      Eryny allued to the difference between men and women with heart attack symptoms and provided a link to substantiate her point. Very nice.
      However, from personal experience, I'd like to point out that
      1) it is also less common for men to have the crushing left sided "classic" arm and left sided chest pain caused by a heart attack (the left sided grab the chest collapse is "old school" thinking)
      2) pre-existing conditions like a breathing disorder (COPD) or metabolic disorder (diabetes) can modify the symptoms of a heart problem so that they aren't recognizable as a "classic" heart attack
      and I hate to say it but...
      3) in the field we are not medical doctors and it is not our job to diagnose someone... so try not to get caught up in "diagnose" the person, because you can miss something...
      In this example, the woman could have one of a number of physical problems related to the organs of the upper body including but not limited to aortic or thoracic anyeursm (weakening of the artery in the main trunks), plumonary disease (breathing disorder), pulmonary edema (water in the lung), exercise induced asthma, pneumonia, pulmonary embolism (clot in the lung), coronary spasm (muscular narrowing of the arteries supplying blood to the heart), congestive heart failure (weakened heart which causes water to back up into the lungs), heart block (where the top and the bottom of the heart don't communicate/function properly), coronary artery disease (umbrella term to include anything that affects the function of the heart because of clotting of blood vessels), severe allergic reaction to an unknown allergen, some kind of cancerous tumor (particularly lung is found late in the game) and to a lesser extent some kind of abdominal pathology.
      Rather, I recommened that we focus on the very drilled in first aid skills...and recognize early that this woman needs early medical attention.
      Get permission to assist, get 911 enroute, and do the ABCs - maintain her airway, coach her breathing and be prepared with universal precautions barriers if needed to perform AR, and watch/treat her circulation: rest, recumbent posture or shock position, treat her for shock, nothing by mouth and be prepared for CPR if required. Do your secondary assessment when you know your ABCs are covered, just to make sure you haven't missed anything.
      Is it helpful to count a pulse? Absolutely... you can tell whether it's too fast or too slow, regular or irregular as you wait for 911.
      Is it helpful to take a BP? Not necessarily... if she has a radial pulse then her pressure is satisfactory for the time being. If not, she's sick and needs to be supine and see medical attention sooner rather than later.
      Is it helpful to count her breathing rate? Sure... but there isn't too much you can do about it at the moment. What's more important is the coaching and monitoring whilst waiting for 911.
      Do you sense a theme in my long winded answer here? This woman needs medical attention is the bottom line. Early access to emergency medical care is the first link the Chain of Survival for cardiac care.
      Don't wait and try to fix her yourself because there really isn't too much a first aid responder can do in this situation other than monitor, coach/calm, treat for shock and wait for either the arrival of the ambulance or the person to become ill to the point of unconsciousness.
      Also, I say let the paramedics argue with the patient about whether or not to go to hospital. They have the legal document that absolves them of responsibility should the person refuse. As first responders, we don't. This person is not well and you have no idea of telling what is wrong with her.. Neither does she. Quite simply if she refuses to have any help until they arrive (or even afterwards), then any good first responder or paramedic will hang around and visually monitor her until she either gets worse to the point of unconsciousness (and then they can help with her implied consent) or until she improves through rest alone.
      That having been said, I'd still have 911 enroute if she improves even if she declines to go. And I'd still tell her that she needs to seek advanced medical assessment even if she improves when sitting at rest.
      well there is my short answer with a lot of words.
      who gave me a keyboard when I'm tired and tend to rant?
      Happy Holidays everyone!
      and be well
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