Thursday, 9 February 2012

The Ass in Assumption

"56 year old female, chest pain"

Chest pain is a funny old job. More often than not it is a LOB. Muscular chest pain, panic attacks, drugs, abdo pain, heartburn and indigestion. Obviously due to risk of heart attacks it is a very high priority call and rightly so. Cardiac care in London is of such a high level, if there is a chance it is a heart attack the sooner we are there the better. Survival rates are improving year on year and if it is a heart attack you will normally be on the table in the Cardiac Catheterisation Lab within an hour of phoning for an ambulance. This particular day had been a day full of rubbish. A collection on man-flu, vomiting and period pains. This job had 'potential' but we'd have to wait and see if it followed the calibre of the jobs thus far. We pulled up outside the house to see an FRU already there. The job was only 4 minutes old so he must have been round the corner. We went inside and were taken to the UPSTAIRS bedroom by the patients husband. 

The FRU was knelt down at the bedside, the patient was sat up in bed and to be honest looked like crap. Pale, sweating and in obvious discomfort. Unfortunately the guy on the car looked equally like crap but for different reasons. Hair was a mess, unshaved, shirt untucked, no epaulettes, creased, chewing gum and laces undone. Uniform is a pet hate of mine. We are a uniformed service and as such you represent your service and your colleagues when you wear it. The is no excuse to look as scruffy and unprofessional as he did. My crew mate had disappeared off to get the chair while I found out what had been going on. She had a sudden onset of pain 15 minutes ago in the centre of her chest, the pain was also in her jaw and left arm. She described it as a crushing pain.  The FRU took her pulse, blood pressure, temperature and BM and then said the following:

"Well, your OB's are fine, I'm pretty sure it's not your heart, grab your things together and come down to the ambulance"

He then looked at me and rolled his eyes. Was he for real?! Was he not seeing or hearing what I was?! She had a great cardiac story, she had risk factors (overweight, smoker, diabetic and hypertension), she was clammy, the pain was radiating and she had chest pain!!!

"It's OK, you stay there, my crew mate is getting a chair for you, we'll pop you down to the ambulance and do an ECG to have a look at your heart and then decide what to do. Is that OK?"

She agreed and looked rather relieved. That clearly pissed off the FRU but at this point I didn't care one iota. We got her down to the truck and wired her up to the Lifepack. As here initial rhythm came up on the screen the FRU chipped in again and said to the patient in a cocky tone and a wink:

"From here it looks alright, you'll be fine"

What an ass! About three seconds later the ECG printed out. Unsurprisingly she WAS having a heart attack. For those in the medical know it was a huge anterior MI with reciprocal changes and at least 12mm of elevation in V 1, 2 & 3. For those not in the medical know, it was a massive heart attack! The FRU sheepishly moved to the back of the truck whilst I explained to the patient and her husband what was happening and what was about to happen. A lot was about to happen very quickly, I was going to cannulate her, give her morphine, more GTN, blood pressures and ECG's galore on route, lights and sirens, a procedure in an operating room and all within the next half an hour. It is daunting but she took it in her stride and stayed calm. We put in a blue call to the cath lab (heart attack centre) and headed off. The FRU chose not to come with us........

We pulled up at the hospital and the back door swung open. The lead cardiologist was waiting to see the ECG. I passed them out to him and gave the handover whilst we were wheeling her into the hospital and to the lab. We transferred her to the table and left her with a swarm of Dr's and nurses prepping her for the procedure. We sat in the viewing gallery and watched. 20 minutes later the cardiologist came out with a petri-dish in his hand. In the dish was the clot that caused the heart attack. It was tiny! Our patient was now pain free and her ECG was normal and would make a full recovery, albeit on medication for life. Amazing! The joys of modern medicine.

This was a great job and highlighted a number of things good and bad. Firstly, call 999 for chest pain. If it IS a heart attack you will get the best treatment in the world and quickly. If you look at the times on this job, you can see why survival rates are so high.

Onset:                  21:50
Call connect:        21:58
Dispatch:              21:59                   *Balloon is the term for when a stent is in-situ
On scene:             22:03                     and the coronary blockage is cleared.
To hospital:          22:21
At hospital:           22:29
Balloon*:              22:55

Onset to Balloon:    1 hour and 5 minutes

Secondly, never, never, never, tell a patient they are fine when they clearly are not and never say "It's not your heart" when it clearly is. Don't commit to a diagnosis and don't mislead or lie to a patient. You get caught out will look like an ass. Finally if you have a uniform wear it properly and if you have an attitude, loose it.  It makes you look like an ass. I can't stand these people, luckily they are rare but they are ones who get the complaints and their image is reflected onto all of us. If you have the job and hate your patients leave. Rant over! x

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