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Re: [E-Chir] Scenario 4

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  • Bethoc (Lesley)
    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
    Message 1 of 6 , Dec 21, 2009
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      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
      Bethóc
       
      Per saltire purpure and gules, a sea-unicorn argent within a bordure per saltire Or and argent
       
      Golden Otter Pursuivant, Kingdom of Ealdormere
      Pursuivant, Canton of Vest Yorvik, the High Seat of Septentria
       
      Ut sit magna, tamen certe lenta ira deorum est
      The wrath of the gods may be great, but it certainly is slow
      what does {o'} mean? See Da'ud notation: http://www.sca.org.au/herald/commentary/Da'ud%20Notation.htm 
       
      solis sacerdotibus. Ave atque vale.


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    • Wolf
      Since Mary is now 50, she can not be classified as a spring Chicken any more. All of us non spring chickens now know that the activities of the day can
      Message 2 of 6 , Dec 22, 2009
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        Since Mary is now 50, she can not be classified as a "spring Chicken" any
        more. All of us "non spring chickens" now know that the activities of the
        day can leave us with all kinds of misc aches and pains, However Alarm bells
        go off as soon as she mentions the fatigue, shoulder pain, shortness of
        breath and nausea along with her story of exertion ( which could explain the
        sweating, but somehow I doubt it ). I would also be enquiring about her
        state of balance, has she experienced any headache or dizziness in the last
        24 hours.

        Although a heart attack is classically associated with severe pain across
        the chest, many people feel only a tightness or squeezing sensation in the
        chest. The discomfort of a heart attack may be confined to the arm, upper
        back, neck, or jaw. Some people only experience a feeling of indigestion,
        nausea, shortness of breath, or sweating. The discomfort associated with a
        heart attack usually lasts several hours. Other ailments such as Angina can
        cause identical symptons but are usually shortlived. I would be politely
        asking Mary about any history of cardiac issues, and would want to check her
        heart rate. If elevated then there is another clue.

        In any case I would be stongly suggest higher level medical intervention as
        soon as practical if not an immediate call to EMS

        Farquhar
      • b1laxson
        While reading it definitely starting have the heart attack flag go up. Its been pointed out though it could be many other things. From experience as a First
        Message 3 of 6 , Dec 23, 2009
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          While reading it definitely starting have the "heart attack" flag go up.

          Its been pointed out though it could be many other things.

          From experience as a First Aider/Chirurgeon it is particularily awkward when the 1st Aider feels there is a potentially fatal situation developing.

          Arranging for transport by paramedics is the way to go. It was particularily frightening having a possible fatality in a POV (personally owned vehicle). Its been a mental shift to be thinking "get them medical care" instead of "to the hospital". Alot can happen on the road which the paramedics can deal with.

          It is though very frustrating when the person goes "no no, don't call". Guidance has been to favor calling 911 to have them encourage the patient. Also, as someone else has already reminded us when they pass out "implied consent" comes into affect.

          Brian the Green
          1st aider
        • Kathleen Gormanshaw
          ... The nice thing about all those possibilities are ALL of them need me to call an ambulance. Well, nice might not be the best word, maybe simple . So my
          Message 4 of 6 , Dec 23, 2009
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            On Mon, Dec 21, 2009 at 10:34 PM, Bethoc (Lesley) <bethoc12thc@...> wrote:


            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.
             
             
            The nice thing about all those possibilities are ALL of them need me to call an ambulance.  Well, "nice" might not be the best word, maybe "simple".  So my course of action is the same, no matter what I imagine the problem to be.
             
            Eyrny
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