What were you thinking?
The call comes in at 5:45am. I get off at 6:00am. The next crew is not in yet and the all other trucks are on runs already. The call is at a nursing home at the very far edge of our area. Off we go. My partner and I are both medics, so we switch off on "who's run" it is. We both do our medic skills, but only one is "in charge"...and has to do the paperwork. This is his run. We are dispatched for a Breathing Difficulty.
80yo female. Earlier in the night she had shortness of breath and jaw pain. The nurse at the nursing home gave her three nitros (one at a time) and the pain went away. The pain came back later, they gave her two more nitros and the pain is still there. They call for us. The pt has no significant medical history other than dementia.
We get there and do our thing, get a report for the nurse while walking down the hall, get vitals, move pt to cot, etc. Pt is awake and talking as normal for the pt. Only complaints are jaw pain and shortness of breath. I'm starting to think possible MI (heart attack)...
On the way out to our truck, the nurse wants us to wait for her to finish her paperwork...quite a bit left. I told the nurse we would be in the truck and she'd need to bring it out to us there.
In the truck, we have the pt on O2, hook the monitor up, start an IV and draw blood tubes for the hospital. My partner was unable to find any good veins on his side of the pt but I did and was able to get an 18 gauge in her right anti-cubital area (inside of elbow). After getting the IV, I see what the monitor says (my partner placed the monitor while I did the IV). She has S-T elevation in leads I, II, and III. There are the only leads available to me. I am still thinking possible MI.
I get out to start heading to the hospital, my partner does not need me anymore and it would be best to start moving. The nurse gives my partner the paperwork and we are off.
On the way there my partner does not seem to be doing much, if anything for the patient. But, maybe I am missing something because I am trying to drive in morning traffic.
We get to the hospital, get the patient in the room. He gives his report while I am out getting the truck cleaned up and cot back in it. When he is back out he calls dispatch and tells them we are available with a Retro of 6 (Difficulty Breathing). Mind you, the Retro-code is how we tell dispatch what the run really was..a check for their dispatching to see if what they tells us we are going to is what we really get. Now, I am shocked. Was I the only one seeing a possible MI here? Luckily, I saw the ER nurse after that and they thought MI too and were caring for the patient properly. Ends up my partner did nothing other than O2 for her. Seems her jaw pain wasn't severe and he did not connect any of the dots. He was going down some sort of breathing difficulty protocol in his head...she did not have wheezing...just short of breath..slightly panicked breathing...ummm..hello??? Could it be because of referred MI pain to her jaw. It's common in women to not have "classic" substernal chest pain with an MI. Heck, the nitro relieved the pain earlier in the evening..should that have not been a clue?
I am going to stop ranting now..I need to get to work. My partner has been a medic for about one year...this is the second service he has worked at..he has been in this service less than 90 days. I was hoping to be partnered with someone experienced...now I am worried.
Anyone else see a possible MI?
To my partner who hopefully never reads this blog:
What were you thinking?
*******
PS - I know I am leaving a bunch of details out of this...some may even be useful for you to form an opinion, but this run actually happened some time ago and this is all I have left in my memory.
80yo female. Earlier in the night she had shortness of breath and jaw pain. The nurse at the nursing home gave her three nitros (one at a time) and the pain went away. The pain came back later, they gave her two more nitros and the pain is still there. They call for us. The pt has no significant medical history other than dementia.
We get there and do our thing, get a report for the nurse while walking down the hall, get vitals, move pt to cot, etc. Pt is awake and talking as normal for the pt. Only complaints are jaw pain and shortness of breath. I'm starting to think possible MI (heart attack)...
On the way out to our truck, the nurse wants us to wait for her to finish her paperwork...quite a bit left. I told the nurse we would be in the truck and she'd need to bring it out to us there.
In the truck, we have the pt on O2, hook the monitor up, start an IV and draw blood tubes for the hospital. My partner was unable to find any good veins on his side of the pt but I did and was able to get an 18 gauge in her right anti-cubital area (inside of elbow). After getting the IV, I see what the monitor says (my partner placed the monitor while I did the IV). She has S-T elevation in leads I, II, and III. There are the only leads available to me. I am still thinking possible MI.
I get out to start heading to the hospital, my partner does not need me anymore and it would be best to start moving. The nurse gives my partner the paperwork and we are off.
On the way there my partner does not seem to be doing much, if anything for the patient. But, maybe I am missing something because I am trying to drive in morning traffic.
We get to the hospital, get the patient in the room. He gives his report while I am out getting the truck cleaned up and cot back in it. When he is back out he calls dispatch and tells them we are available with a Retro of 6 (Difficulty Breathing). Mind you, the Retro-code is how we tell dispatch what the run really was..a check for their dispatching to see if what they tells us we are going to is what we really get. Now, I am shocked. Was I the only one seeing a possible MI here? Luckily, I saw the ER nurse after that and they thought MI too and were caring for the patient properly. Ends up my partner did nothing other than O2 for her. Seems her jaw pain wasn't severe and he did not connect any of the dots. He was going down some sort of breathing difficulty protocol in his head...she did not have wheezing...just short of breath..slightly panicked breathing...ummm..hello??? Could it be because of referred MI pain to her jaw. It's common in women to not have "classic" substernal chest pain with an MI. Heck, the nitro relieved the pain earlier in the evening..should that have not been a clue?
I am going to stop ranting now..I need to get to work. My partner has been a medic for about one year...this is the second service he has worked at..he has been in this service less than 90 days. I was hoping to be partnered with someone experienced...now I am worried.
Anyone else see a possible MI?
To my partner who hopefully never reads this blog:
What were you thinking?
*******
PS - I know I am leaving a bunch of details out of this...some may even be useful for you to form an opinion, but this run actually happened some time ago and this is all I have left in my memory.
posted by MidwestMedic at 14:20
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