Chest pains

[dhpd9807]

When did we start treating pts based on "it's not gonna hurt 'em" NTG is not something used to R/O cardiac, it is used to treat cardiac c/p and on very rare occasions, hypertension. I would love to hear what this guy's problem was but as far as I can tell he'll get a line, some o2, and unfortunatly the monitor because that's what the powers that be think I should do. I think the chances of this kid having a cardiac event are pretty slim.

 

[Jon]

When did we start treating pts based on "it's not gonna hurt 'em" NTG is not something used to R/O cardiac, it is used to treat cardiac c/p and on very rare occasions, hypertension. I would love to hear what this guy's problem was but as far as I can tell he'll get a line, some o2, and unfortunatly the monitor because that's what the powers that be think I should do. I think the chances of this kid having a cardiac event are pretty slim.

The patient had Chest pain, and a blood pressure above 100 systolic. Pt. has no known cardiac problems, but neither did Jim Page.... Patients have MI's with no real warning all the time. Could also have been drug related.

I just looked at my County's ALS protocols... there is no contraindication of Nitro for "suspected ischemic chest pain" EXCEPT Viagra/Levitra/Cialis etc.

I think giving ASA and Nitro isn't a bad idea... but I would call the Doc before doing anything if I had any questions.

 

[mightymom7]

Wow, I just read this entire post....out protocols don't allow us to give anything for abd pain -- don't want to mask symptoms. CP however is treated with ASA, NTG, and morphine if pain not relieved by NTG. I would have definitely called med control about this one. And would have definitely been palpating the abd to try to locate where the pain was, especially since the pain was on the move. Didn't sound like classic CP, then however, not everyone has the "classic symptoms."

Thanks for sharing this call info....was definitely something to put into the ole memory banks for future reference.

 

[jewls]

I am right with you!

:excl: -_-

Recruiting, While I appreciate your input, I would love to know what your certification level is... how long have you been in EMS?

Without lashing out, and with respect, I would like to reply with these few points.

You wrote; The physical movement of the pt's trunk with each breath would have made the patient scream in pain, any movement would. He did not do this.

First of all, not all patients can be treated "By the book". With that said, the key thing in EMS is that unfortunatly, we are NOT doctors (although I would love to make thier money!!!), therefore, we do not diagnose in the field, we simply treat the symptoms. I am not sure where you practice at, and really don't care, but if you were on this call with us, (which you obviously were not), you would know that our protocols were followed for a reason. If you are not up to par on your medications, here is a run down on pharmacology.

ASA - first line drug for chest pains (after 02 ofcourse)
Nitro - Nitro is given to relieve chest pains, providing that we have an IV started and the B/P is above 90 systalic.
Morphine - Chest pains, and pain management in general

It was a 25 - 35 min. transport from the best of my recolection. I can tell you from personal experience, not from the book, and this is what they don't teach you in class, Gall Bladder attacks, weather or not it is ruptured, however mine did rupture, can mimic a cardiac event. There is not always tenderness present in the RUQ, I too did not have that. The cardiac protocols were gone through for process of elimination. It did not hurt him to take an ASA, nitro did not hurt him, but it did not help him. This varified that there was no cardiac event going on. Morphine was used for pain management... if you were there, you would understand that something had to be done to help him tolorate the pain. All of the above treatment is the plan of action set up by our OMD to rule out a cardiac event. We don't have to call in for anything, although sometimes it helps us feel better to get the go ahead from the ER doc on drug choices. All of our drugs are on standing orders. The only reason we usually call in is to give report. By the way, You said that the cardiac event could have been ruled out at the scene... I AM ALS, and I don't claim to be a doctor!!!! I had another ALS provider with me also.

We are a very agressive squad, and region for that matter. Our OMD wants us to be agressive. Alot of the treatment differences come from protocol differences... and EXPERIENCE IN THE FIELD. Listen to your patient, evaluate your symptoms, treat the symptoms... don't try to play doc! It is impossable to compleatly diagnose in the field!!!!!!!!!!!! Never reasure the patient in the field... this is outlined in the 2003 Mosby edition of "The Basic EMT". We can try to keep them calm, but it is discouraged these days to reasure. This gives the patient false hope.

It is ok to work out a scenario, but do not try this "I know all and you know nothing attitued". You will not make many friends here. You don't have to try to impress anyone here. We all get together on here, we don't bash eachother, or try to make people look or sound stupid, we get together to discuss our experiences in the field and talk out calls with other providers. You might want to consider reading other entries before you post another "know it all" reply. Try learning more about what you are talking about before you try to quote treatment plans in the way that you did on here. With respect! I hope others will agree with me.

I do agree with you totally! We are here to learn and share. I love your response! Very professional and right on!

 

[TTLWHKR]

I just looked at my County's ALS protocols... there is no contraindication of Nitro for "suspected ischemic chest pain" EXCEPT Viagra/Levitra/Cialis etc.

I think giving ASA and Nitro isn't a bad idea... but I would call the Doc before doing anything if I had any questions.

Ditto. I treat all CxPn patients on a case by case basis, no call is the same, unless it's BS... O2, monitor, NS IV, 4 Baby ASA, 1 squirt Nitro, possibly some MS, depending on the pain level and pressure.

Unless the patient is hypotensive, or has taken some sort of enhancement drug.. The Nitro will give them a headache, but one dose really won't hurt them. We're giving it pre-hospital, which will aid the MD in diagnosis, we are giving the patient medications to see if they will stop, reverse, or aleviate pain and damage to cardiac tissues. So the basic concept is, we're giving it to the guy and if it helps, great.. if it doesn't, it really won't hurt anything. So yes, that is the way we treat people. If it wasn't, it wouldn't be a standard of care.

 

[MecklenburgEMT_RS20]

This not Cardiac related

I have had a similar call to this....it was for the same age group and same description of pains. It turned out when we got to the hospital it was gall stones. But it showed all the S/S's of cardiac related problems....he was vomiting...SOB....Cx. Pains in both arms....and then the abd. pains..
The doc told us when we went back up there that night that it was a gall stone....
So sometimes you just never know do you.

 

[emtbass]

with my als experience i would say O2, large boar IV, 12 lead, ASA, and nitro and rapid transport.

The 12 lead would help determine the cardiac portion of it.

 

[EMTMandy]

Could be a DVT/PE too.

 

[KEVD18]

well im glad we brought back an almost two year dead thread for that tid bit.

 

[TKO]

just for the confusion regarding abd quadrants, I offer this link with some good, basic information:

http://www.geocities.com/pcpsk/abs.html


FTR: I wouldn't have guessed gall bladder, but I knew it wasn't cardiac. Referred pain can also come from the abdomen as it is the same nerve moving up past the heart and into the shoulders and arms. The high BP suggested a blockage, so I thought spleen or even kidney (tho a lower back pain would have been more common for the kidney).

But hey, abdomen is a tough guess for anyone.

 

[lancymoor102]

can tell me what it is or what to do?

Hi, I am only 22 years old female and a soccer player. I get really bad pains in my feet and ankles. Some times it affects my knees. I can’t seem to tell it the pain is in my bone or muscle but generally it feels like a deep dull pain. Also I find massaging and pushing down with my fingers into the areas where the joints/bone are help. Has anyone experienced this pain and can tell me what it is or what to do?

 

[Ridryder911]

It could be mulitple things from ranging from inflamed joints, tendonitis, athritis, gout, etc.. The only lodgical advice is to seek medical attention per your physician. Only they can truly assess and treat accurately.

Good luck,

R/r 911

 

[KEVD18]

wouldnt this be more suited for its own thread and not a post in a thread started years ago?

 

[Topher38]

i thought this was the BLS section?

 

[KEVD18]

and???

ever gotten an als intercept? so the call starts with a bls response and then at some point the medics jump in and do their thing? that happens on the bls board sometimes.

 

[MSDeltaFlt]

Hi, I am only 22 years old female and a soccer player. I get really bad pains in my feet and ankles. Some times it affects my knees. I can’t seem to tell it the pain is in my bone or muscle but generally it feels like a deep dull pain. Also I find massaging and pushing down with my fingers into the areas where the joints/bone are help. Has anyone experienced this pain and can tell me what it is or what to do?

Lancy,

Rid's right. Go see a doctor AND a physical therapist. For several reasons:

1. If you're a new athelete at 22, you're throwing your feet and joints into a state of shock. If you don't figure out what you're doing wrong, only one thing will happen.. it'll get worse. It won't go away by itself. Doctors can fix the problem. PT's can show you how to do it right so it won't happen again.

2. If you're still an athelete at 22, you've been here before. This ain't your first rodeo. You're still doing something wrong and it won't go away by itself. Doctors can fix the problem. PT's can show you how to do it right so it won't happen again.

3. Just because you're a young, healthy athelete, doesn't mean you automatically know how to do things right. It's OK. None of us know how to do things right. That's why God created doctors and PT's. Doctors can fix the problem. PT's can... need I go on?