Jon,
No offense taken and I can certainly appreciate your point. The intent behind the comment was certainly not to look for the simple excuse for the problem. It is simply meant to motivate our medics to do like you imply and be more thorough in their assessment wether it be through verbal questioning or hands on. I have even had the pt. with the MI that caused the accident. I believe however that with proper questioning of the conscious trauma patient you can rule out a myriad of underlying problems. Getting into questions about their chest pain can certainly help with that. By simply asking them, " does the chest pain feel like it's on the surface or inside?" Did you have the pain before the accident, if so does it feel the same now or is it different and how?" "Does the pain worsen with inspiration/ exhalation, or with palpation?" "Do you have pain anywhere else with it?" are just a few to start and certainly not the end all.
Obviously if the pt. is unconscious the questioning goes out the window and you need to rely on other tools (i.e. EKG changes; irregularity, T-wave progression, ST elevation in Lead II, even though it only can show the possibility of an Inferior Wall MI) most times unless your transport times are long the 12-lead falls down low on the priority list of an unconscious trauma victim.
Like you stated, it is definitely the great medics that can make the differential diagnoses CORRECTLY and not take the easy way out. My philosophy is and has always been, BE AGGRESSIVE, for it's better to be in front of the 8 ball than behind it. All my patients are treated like they are a member of my family because that is what I would expect if I or a loved one were to ever need emergency medical services.
Great point Jon.
Thanks
