A Cardiac case

Great reminder of the importance of suspicion.

When taking care of patients with emergency symptoms, whether it is in the ED or in the field, we all start to recognize situations that give you a sense of impending doom. in the ED, the nurse's movements in and out of a room may catch my attention while I am working at my desk, and something tells me I should step into that room sooner rather than later. In pre-hospital cases, sometimes you just know that you are about to have a patient that is going to require your expertise in order to survive. It may be the tone of the dispatcher's voice, or there may be nothing other than your own gut feeling. We have all looked at someone, not knowing their vitals, history or current symptoms and instantly worried that they might die in the next few moments.

The case I had the other day was one of 3-5 patients per shift I see with chest pain. I heard the nurse bring the patient into the room behind me, and I did my work waiting for the ECG to be placed on my desk.I am not sure what caught my attention, but I distinctly remember them getting him into the bed. Then,  there was a delay in getting the EKG in my hands. For some reason, my gut said I needed to see his EKG before I started on another patient.

 Here it is:

He has no chest pain:

Not much to see, is there. So I thought, " Huh, my gut feeling was wrong this time"

When I went in to see him 10 minutes later, he looked uncomfortable and the QRS shape on the monitor looked very concerning.

He said that he was having chest pain again, like what had brought him in from work today. My "spidey sense" sense had told me to pay attention to this patient, and now my suspicions were confirmed.

Here is the EKG when he was having pain:

At this point he was sent to the cardiac cath lab and had a stent put in his right coronary artery.

A few things I will stress related to this case. 

Develop your gut feeling or " Spidey sense". It has really come in handy in the years I have been doing this job. If you listen to your gut, and find out it was inaccurate, learn from it and keep going. My gut feeling is something I have learned to rely on and not ignore it just because it is wrong on occasion.

Gut feelings have saved many a life in EMS. Just recently I was passed a note from an ED MD in town who says an Allina crew saved a patient's life. They had the gut feeling something bad was happening with the patient and insisted she be triaged to a critical room. There were no bad vitals and no significant exam finding. The providers just had a bad feeling. This turned out to be exactly where she needed to be when she nearly bleed to death from an ectopic pregnancy

Next, it is OK to do as many EKGs as you want. Keep trying to get a picture of the STEMI that you think is evolving.

Paul