# Near the bridge, down the creek, for the chest pain call.



## abckidsmom (Mar 30, 2013)

(Or, why I *love* rural EMS)

At midday, you are dispatched for a male in his 60s who was panning for gold on the creek when he had a sudden onset of chest pain and diaphoresis. 

You arrive, and head down to the creek, and see a guy waving you in about a quarter mile away. It's an ankle deep rocky creek- a 65 degree day, water temp is in the 50s. 

What do you bring in? Who's carrying it? What resources do you need?


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## AzValley (Mar 30, 2013)

I am bringing a jar for all the gold


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## abckidsmom (Mar 30, 2013)

AzValley said:


> I am bringing a jar for all the gold



Awesome.  Definitely an important consideration.  We didn't even get a chance to look for it, his buddies were cleaning all that up.


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## AzValley (Mar 30, 2013)

What part of Virginia was this?  I lived in Charlottesville for 12 years before moving to the desert.


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## CritterNurse (Mar 30, 2013)

I would be calling for a paramedic and depending on how many have signed on, chances are I would be calling for firemen for lift assist. Since it sounds like the patient is where an ambulance can't get close, I would want to bring down:

The ECG monitor/AED
A backboard and straps (in case CPR is needed, or the patient needs to be carried out)
The 'first in' bag (contains oxygen, as well as other supplies)
The 'paramedic' box (contains ASA and nitro)
A blanket or two, and a couple towels
The clipboard (for taking down info)
Two-way radios and/or cell phones that get reception in that area.

The items would be carried by who ever is available to come down. Worse comes to worse, everything could be piled onto the backboard, strapped down with a blanket and straps, and lugged in that way with a person on each end.


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## abckidsmom (Mar 30, 2013)

PMed ya.


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## abckidsmom (Mar 30, 2013)

CritterNurse said:


> I would be calling for a paramedic and depending on how many have signed on, chances are I would be calling for firemen for lift assist. Since it sounds like the patient is where an ambulance can't get close, I would want to bring down:
> 
> The ECG monitor/AED
> A backboard and straps (in case CPR is needed, or the patient needs to be carried out)
> ...



Who's carrying that stuff? How are you doing this?


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## CritterNurse (Mar 30, 2013)

abckidsmom said:


> Who's carrying that stuff? How are you doing this?



Looks like you posted this as I was editing my post to say who was carrying what.


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## Rialaigh (Mar 30, 2013)

Im taking a bottle of asprin and walking down there. Leaving my partner at the ambulance and requesting fire department assistance. If the guy walked a 1/4 mile down the creek Im going to have him chew 4 aspin up while walking back to the ambulance. I think it would be a fair assumption to say he walked as far if I am at the closest access point, so not to much of a stretch to have him walk back.

 If it looks like a legitimate @#$@#$ me situation where he's lying on the ground sweaty, breathing hard, not able to get complete sentences out and just looks unstable then I am going to have him chew 4 asprin and Lie in the water (that is in the 50's) and essentially induce hypothermia while waiting on fire department assistance.


I am not carrying equipment down there that I cannot effectively use. If there are 10 bystanders then sure but as far as what I take...some asprin and a towel maybe, to dry my hands so I don't get cold...


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## abckidsmom (Mar 30, 2013)

Rialaigh said:


> Im taking a bottle of asprin and walking down there. Leaving my partner at the ambulance and requesting fire department assistance. If the guy walked a 1/4 mile down the creek Im going to have him chew 4 aspin up while walking back to the ambulance. I think it would be a fair assumption to say he walked as far if I am at the closest access point, so not to much of a stretch to have him walk back.
> 
> If it looks like a legitimate @#$@#$ me situation where he's lying on the ground sweaty, breathing hard, not able to get complete sentences out and just looks unstable then I am going to have him chew 4 asprin and Lie in the water (that is in the 50's) and essentially induce hypothermia while waiting on fire department assistance.
> 
> ...



So somewhere in the middle of the equation, you take the monitor and bag with a small med pack with Asa and nitro, albuterol etc. full med pack stays at the truck. Oxygen is in the bag. 

You get to him and find him tripoding, working to breath, complaining of chest pain radiating to neck and shoulder, nausea, with pale sweaty skin. 

First vitals: 

BP 106/74
HR 78
RR 22
SPO2 100% on room air







This is the EKG. 

He weighs 275.


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## adamjh3 (Mar 31, 2013)

Yup. I'd call that an inferior STEMI. I'd initiate my ACS protocol and hopefully I was smart and called ahead for additional manpower. I'm assuming the "med bag" you mentioned has a start kit and a liter saline bag, so, while I'm waiting for my lift team with a stokes basket or break away flat. I'd get him on 2-4Lpm O2 via NC (per protocol) give him 324mg ASA, get a line going with the big bag. I'd be comfortable starting with 0.4mg of NTG SL with that pressure and that EKG as long as I have a line established to combat hypotension. I'd consider using remaining time to prep some dopamine just in case. 

He's a big boy, and I didn't hike him out into the woods and give him a heart attack, so I'm not going to bust my back getting him out without proper manpower so I'm going to do what I can for him on scene until we can safely evacuate him. I might have my partner poke around nearby to see if there's any paths or roads we can get the ambulance down that are closer than that 1/4 mile hike. Chances are Pannin' McHeartattack and his friends are pretty familiar with the area, so probe them for information. 

I would probably have my partner go back to the rig to lead fire in and give them a quick run down. If the guy codes I've got his two buddies to help me with CPR.


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## abckidsmom (Mar 31, 2013)

We ended up starting an IV, giving aspirin, and I held off on nitro. I didn't bring the monitor down with me into the creek, I was just going off of the assessment. He looked Sick. 

We carried him out with a 6-man carry in the stokes basket, and got that EKG in the medic unit on the way to the LZ. He was in the cath lab 30 minutes later, getting his occluded MCA opened and stented. 

He said they are planning for a Monday discharge. This was a STEMI win.


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## RocketMedic (Apr 2, 2013)

Hmm...if he's near the bridge, we can get the truck onto the bridge and rope-lower it.

If he's not, we're getting the SKED litter, the monitor, the PM box and the airway bag and going for a hike. If we can't carry it all, the airway stuff is the first to go. 

I don't think we need to walk him, but silly question- do we have rope?


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## abckidsmom (Apr 2, 2013)

We had rope. We also had 6 people and no more. He was about a quarter mile from the bridge, and the last jaunt up the hill was a steep but drive able rutted gravel path. The opposite bank there was a very steep incline and before we found that path there was talk of a z-drag to get him up that incline. 

We had a pretty decent ropes setup on the engine on scene, and the manpower from another unit to help as well.


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## abckidsmom (Apr 2, 2013)

I and regret not bringing the monitor with me. That could have turned out Very Bad.


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## Handsome Robb (Apr 2, 2013)

Sounds like a cool call!

I'd say he's a little sick. It'd be nice to have a monitor but one other though is an AED if theres one around. Lighter, smaller and cheaper if you drop it in the water. 12-lead when you get back to the truck will still give the cath lab enough time to spin up. 

It'll do what you need if he goes south. Unfortunately wont know the rhythm but you can make a pretty good assumption


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## Tigger (Apr 2, 2013)

Robb said:


> Sounds like a cool call!
> 
> I'd say he's a little sick. It'd be nice to have a monitor but one other though is an AED if theres one around. Lighter, smaller and cheaper if you drop it in the water. 12-lead when you get back to the truck will still give the cath lab enough time to spin up.
> 
> It'll do what you need if he goes south. Unfortunately wont know the rhythm but you can make a pretty good assumption



Heck even most "professional grade" AEDs will show you the rhythm if you set them up properly. Doesn't mean you can do much with it though...


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## katgrl2003 (Apr 3, 2013)

My first response when I saw the EKG was "Oh, :censored:"


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## firecoins (Apr 3, 2013)

abckidsmom said:


> We ended up starting an IV, giving aspirin, and I held off on nitro. I didn't bring the monitor down with me into the creek, I was just going off of the assessment. He looked Sick.
> 
> We carried him out with a 6-man carry in the stokes basket, and got that EKG in the medic unit on the way to the LZ. He was in the cath lab 30 minutes later, getting his occluded MCA opened and stented.
> 
> He said they are planning for a Monday discharge. This was a STEMI win.



Alright. Sounds like it went well. And it went down the way I would have most likely handled it.


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## abckidsmom (Apr 3, 2013)

katgrl2003 said:


> My first response when I saw the EKG was "Oh, :censored:"



I know right? I had a paramedic student in the back with me and she earned a gold star. She was setting up a second line while I got him on the monitor. It was evident as soon as I connected the 3 lead- I said "Karen, Look At The Monitor." She was all- oh yes, much of the badness.


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## Bullets (Apr 4, 2013)

Before seeing the strip, i would bring a stokes (from the roof of my ambulance) and my jump kit, and start FD to my location, MICU is enroute from dispatch. We both carry radios, but i would probably have a cop with us too

Administer 325mg ASA and put the patient in the basket, hump him to the truck where hopefully ALS is waiting. Treat monitor and transport


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## Anjel (Apr 4, 2013)

katgrl2003 said:


> My first response when I saw the EKG was "Oh, :censored:"


 
Mine was... "Well that doesn't look good...wait thats a...ohhh very bad bad bad".


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