Was it an MI?

[spisco85]

I first responded with my volly dept. the other afternoon to a chest pain call. U/a 84 yo male complaining of chest pain radiating down left arm with a small complaint of sob. Patient stated pain was 8/10 and felt like "an elephant was sitting on his chest". Patient was diaphrotic and pale. Patient placed on 15 liters nrb and states minor relief to the sob.

History of mi and a recent cath but with no stents placed. Patient stated he had major blokage in coronary arteies. Patient denied taking any asa prior to my arrival. Patient had used prescribed Nitro inhaler three times prior to calling 911 with no relief.
BP: 130/90
Pulse: 90
Resp: 22

I didnt have time to call med control to request permission to administer more nitro. Patient loaded into ambulance and ambulance intercepted with medic. No further information available. So is it an mi? How often will 3 sprays of nitro not dump the bp?

 

[firecoins]

did you have the ability to do 12 leads?

 

[spisco85]

Nope. Bls volly service. I know without the 12 lead it is impossible to tell for sure.

 

[Sasha]

So is it an mi? How often will 3 sprays of nitro not dump the bp?

Did the nitro give him a headache?

 

[akflightmedic]

Nope. Bls volly service. I know without the 12 lead it is impossible to tell for sure.

Then why did you ask?

 

[Scott33]

Well from what you said, it does sound cardiac in nature. Pallor and diaphoresis in the absence of strenuous activity is usually a bad thing.

Do you not have the ability to give ASA?

Nitro can often "dump the BP" depending on the location of the infarct, which is why we should have a line in place prior to giving it.

 

[daedalus]

"Was it an MI?"

No idea. We need 12 lead, labs including serial cardiac enzymes, and a better history physical exam than the three vital signs you listed. Other PMHx? Family history?

 

[carpentw]

You need a 12 lead

 

[irish_handgrenade]

was the nitro in your jump bag or did it belong to the pt?

 

[rmellish]

It's possible the nitro was partially inactive. Not unusual if the tablets have been exposed to air or light for a period of time.

Also, why no ASA?

 

[MSDeltaFlt]

I first responded with my volly dept. the other afternoon to a chest pain call. U/a 84 yo male complaining of chest pain radiating down left arm with a small complaint of sob. Patient stated pain was 8/10 and felt like "an elephant was sitting on his chest". Patient was diaphrotic and pale. Patient placed on 15 liters nrb and states minor relief to the sob.

History of mi and a recent cath but with no stents placed. Patient stated he had major blokage in coronary arteries. Patient denied taking any asa prior to my arrival. Patient had used prescribed Nitro inhaler three times prior to calling 911 with no relief.
BP: 130/90
Pulse: 90
Resp: 22

I didnt have time to call med control to request permission to administer more nitro. Patient loaded into ambulance and ambulance intercepted with medic. No further information available. So is it an mi? How often will 3 sprays of nitro not dump the bp?

Straight up and honest with you without being condescending. First off, you cannot confirm an AMI without either a 12 Lead and/or certain cardiac enzymes; hence the terms STEMI (St Elevation MI) and NSTEMI (Non-St Elevation MI). All you can say is he had anginal chest pain.

Was the CP he c/o the same CP as when he had his last MI? Or was it different? And if so, how and to what extent?

If they had an MI in the past, they are prone to have another one. Most people do not change their lifestyles. If he had major blockages with no stents placed, they were probably treating him medically and he's showing evidence it ain't workin'.

Did you give any ASA?

Also, why didn't you have time to call med control? It doesn't take long to make a phone call. Were you feeling rushed? If you're "b*lls-to-the-wall", you might want to slow down a bit because you're liable to miss something important. Just FYI is all.

 

[LAS46]

I first responded with my volly dept. the other afternoon to a chest pain call. U/a 84 yo male complaining of chest pain radiating down left arm with a small complaint of sob. Patient stated pain was 8/10 and felt like "an elephant was sitting on his chest". Patient was diaphrotic and pale. Patient placed on 15 liters nrb and states minor relief to the sob.

History of mi and a recent cath but with no stents placed. Patient stated he had major blokage in coronary arteries. Patient denied taking any asa prior to my arrival. Patient had used prescribed Nitro inhaler three times prior to calling 911 with no relief.
BP: 130/90
Pulse: 90
Resp: 22

I didnt have time to call med control to request permission to administer more nitro. Patient loaded into ambulance and ambulance intercepted with medic. No further information available. So is it an mi? How often will 3 sprays of nitro not dump the bp?

One other question I would need to know is, how long ago did he take the nitro spray? was the medication expired? Did he get a severe head ache after taking the nitro? Did he take any ASA prior to your arrival?

Question to spisco85:
How long was your transport time from the scene to the hospital?
Why did you not attempt to give ASA if the PT had not already recieved the max dose?

I would also need to know what the other medics did on the ALS rig to know if the questions above were taken care of... if they were not then they should have been depending on local protocol. National Registry says that you should have asked those questions that I listed above.

Dustin C.
MFR, NREMT-B Student

 

[daedalus]

One other question I would need to know is, how long ago did he take the nitro spray? was the medication expired? Did he get a severe head ache after taking the nitro? Did he take any ASA prior to your arrival?

None of these questions would help with a differential. In fact, I do not remember where, but I was reading that the use of nitro to rule in/out ischemic causes of CP doesn't even work.

 

[Sasha]

None of these questions would help with a differential. In fact, I do not remember where, but I was reading that the use of nitro to rule in/out ischemic causes of CP doesn't even work.

It's still nice to know if you are giving expired nitro as nitro's got more than just pain relief purposes. It reduces preload through vasodilationd deccreasing the workload of a hurtin' heart!

 

[daedalus]

It's still nice to know if you are giving expired nitro as nitro's got more than just pain relief purposes. It reduces preload through vasodilationd deccreasing the workload of a hurtin' heart!

Yes, but how would that question help determine if the patient is having an MI or not? The OP wanted to know if his patient was experiencing an MI vs. other forms of ACS. Asking if the nitro is expired or not, just because its some algorithm that LAS46 learned in EMT school, will do absolutely nothing in determining the cause of the pain. It is just another robotic question for the EMT to ask because they do not know what they are really doing.

 

[irish_handgrenade]

It is just another robotic question for the EMT to ask because they do not know what they are really doing.

wow...:blink:

 

[daedalus]

wow...:blink:

Mean every word of it.

 

[CAOX3]

Yes, but how would that question help determine if the patient is having an MI or not? The OP wanted to know if his patient was experiencing an MI vs. other forms of ACS. Asking if the nitro is expired or not, just because its some algorithm that LAS46 learned in EMT school, will do absolutely nothing in determining the cause of the pain. It is just another robotic question for the EMT to ask because they do not know what they are really doing.

Well then please enlighten us.

 

[Sasha]

Yes, but how would that question help determine if the patient is having an MI or not? The OP wanted to know if his patient was experiencing an MI vs. other forms of ACS. Asking if the nitro is expired or not, just because its some algorithm that LAS46 learned in EMT school, will do absolutely nothing in determining the cause of the pain. It is just another robotic question for the EMT to ask because they do not know what they are really doing.

Ah, sorry, I was posting from class on my phone, I misread your post :]

 

[daedalus]

Well then please enlighten us.

Enlighten you to what? How to diagnose an MI? It was already covered here well enough by MSDeltaFlt. 12 lead and labwork, along with a H&P and family history. Sometimes a CXR and other studies are done to rule other causes of chest pain out.

Simply asking about whether or not somebody got a headache from taking nitro is not a substitute to proper education. Its a question I could teach a four year old to ask.