This is something that happened to somebody I know/a family member. I am just an EMT-b student, but I did what I could do.
So pretty much what I got from her (I had nothing, not even a watch)...
50 y/o obese female c/o chest pain "feels like somebody is punching me in the chest" followed by SOB. (+) Nausea, (+) orthostatic hypotension, difficulty breathing laying down too (only position of comfort was sitting), slow/progressive onset (over a couple of days), yellow/green sputum (occasionally pink too), pain behind left ear also. Huge amount of alcohol consumption throughout the week. Radial pulse felt fast, but it was also strong and regular. Respiration was fast and labored. Skin was pink and warm, but diaphoretic also.
In the ER, I read off the machines that the pulse was 105, respiration was 26, her BP was about 160/100mmHG, and SpO2 kept changing from 94%-97% (not/never was a smoker). Way out of my scope of practice and knowledge as an EMT-b student, but I've been learning to interpret ECGs on my own and after much practice, I could see that hers was normal.
They took several test including a blood test and found that her alcohol level was really high even though she hadn't drank for about a half a day (this happened in the middle of the night while we were all sleeping).
They let her go same day, told us it was most probably the alcohol, and advised her that this was her wake-up call.
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Anyhow, up until before the ER part with just the information I provided, what would you think and do without any equipment?
What would you think after looking at the numbers I saw in the ER? Do you agree with the conclusion of the healthcare providers?
Oh, and what would you do if you were responding to this call as an on duty EMT of any level?
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As for me, even though it was only a couple s/s of an MI, I thought that's what it was immediately (specially after she said it felt like somebody was punching her in the chest). I figured the (occasional) pink sputum she was coughing up was from too much alcohol consumption. I already gave away what I checked for in my little report before the ER.
After going into the ER, I was very relieved to see her on a nasal cannula (not sure if that's what ERs would do to MI pt., I don't think so, but I am positive an EMT would have her on a NRM) and see that even though numbers where on the high end (especially her BP and respiration), that I didn't think it was an MI anymore (especially after seeing the ECG monitor and seeing that it looked normal). SpO2 had me a lil' curious why it was lower than what I would expected of her (at least 97%+ I would've thought - maybe alcohol lowers that?) I agree with the conclusion of the healthcare providers, but also curious on how alcohol gave her s/s of an MI and how if I ever witness something like this again.. how I would be able to recognize the difference (like I think the pink and warm skin and slightly fast (expected due to anxiety), but strong and regular pulse were signs of it not being an MI). Was a scare, but I would like comments on this to learn from this.
If I was responding to this as an on duty EMT-b, I would've just done my normal pt. assessment, high flow O2 via NRM at 15 L/m. Try to give her emotional support/calm her down, but also make her aware of what's going on (she was in denial the whole time). I forget the name of this position, but I would also have her in a sitting position on the cot (maybe one of you guys can remind me).
So pretty much what I got from her (I had nothing, not even a watch)...
50 y/o obese female c/o chest pain "feels like somebody is punching me in the chest" followed by SOB. (+) Nausea, (+) orthostatic hypotension, difficulty breathing laying down too (only position of comfort was sitting), slow/progressive onset (over a couple of days), yellow/green sputum (occasionally pink too), pain behind left ear also. Huge amount of alcohol consumption throughout the week. Radial pulse felt fast, but it was also strong and regular. Respiration was fast and labored. Skin was pink and warm, but diaphoretic also.
In the ER, I read off the machines that the pulse was 105, respiration was 26, her BP was about 160/100mmHG, and SpO2 kept changing from 94%-97% (not/never was a smoker). Way out of my scope of practice and knowledge as an EMT-b student, but I've been learning to interpret ECGs on my own and after much practice, I could see that hers was normal.
They took several test including a blood test and found that her alcohol level was really high even though she hadn't drank for about a half a day (this happened in the middle of the night while we were all sleeping).
They let her go same day, told us it was most probably the alcohol, and advised her that this was her wake-up call.
--
Anyhow, up until before the ER part with just the information I provided, what would you think and do without any equipment?
What would you think after looking at the numbers I saw in the ER? Do you agree with the conclusion of the healthcare providers?
Oh, and what would you do if you were responding to this call as an on duty EMT of any level?
--
As for me, even though it was only a couple s/s of an MI, I thought that's what it was immediately (specially after she said it felt like somebody was punching her in the chest). I figured the (occasional) pink sputum she was coughing up was from too much alcohol consumption. I already gave away what I checked for in my little report before the ER.
After going into the ER, I was very relieved to see her on a nasal cannula (not sure if that's what ERs would do to MI pt., I don't think so, but I am positive an EMT would have her on a NRM) and see that even though numbers where on the high end (especially her BP and respiration), that I didn't think it was an MI anymore (especially after seeing the ECG monitor and seeing that it looked normal). SpO2 had me a lil' curious why it was lower than what I would expected of her (at least 97%+ I would've thought - maybe alcohol lowers that?) I agree with the conclusion of the healthcare providers, but also curious on how alcohol gave her s/s of an MI and how if I ever witness something like this again.. how I would be able to recognize the difference (like I think the pink and warm skin and slightly fast (expected due to anxiety), but strong and regular pulse were signs of it not being an MI). Was a scare, but I would like comments on this to learn from this.
If I was responding to this as an on duty EMT-b, I would've just done my normal pt. assessment, high flow O2 via NRM at 15 L/m. Try to give her emotional support/calm her down, but also make her aware of what's going on (she was in denial the whole time). I forget the name of this position, but I would also have her in a sitting position on the cot (maybe one of you guys can remind me).
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