# Phone it in



## Simusid (Dec 9, 2009)

This is more of a story than a scenario, so I guess it belongs here.  

I have an online friend who I have never met.  I've known her for a few years and we know each other fairly well, and we communicate primarily via facebook.  We are 1200 miles apart but I was apparently the first person she thought of last night when she had a sudden onset of nausea/vomiting, nosebleed, and "chest pain".  She emailed me last night with a very urgent "am I having a heart attack?  should I call 911?  what do I do?"   She lives alone, is about 50 and this incident occurred while she was trying to get her car unstuck from a foot of snow in the midwest.  

She has some pertinent medical history and cardiac issues were not out of the question.  She called me a few minutes after I replied and I was very ready to say "you have to call 911 RIGHT NOW"    But I thought it would be appropriate to listen to her first, calm her down, offer some support, and maybe figure out what was going on.  It's amazing to me, as a brand new EMT-B, how effective ABC OPQRST SAMPLE is and how it has become second nature to me, even when I cannot see the patient!   I tried to treat this from start to finish as a typical medical call and used her as my eyes and ears and hands.  I started with LOC and A (" a bit frantic but clearly has an airway"), asked her about breathing ("can take a full breath but it hurts"), C  (epistatxis stopped, soaked one full paper towel w/ blood), O sudden, P semi-fowlers pallates, Q localized upper GI pain, R does not radiate,S 7/10, T 1 hour.  S skin dry, pulse strong and described as rapid (no rate), resp rate radid and shallow, possible delayed cap refill, near syncope upon standing (slumped to floor).   A,M, no further info.  P - family history of cardiac issues but none yet for her, L light meal 2 hours earlier, E - high stress roadside situation, car stuck, shoveling snow.  Pain severity had dropped from 7 to 4.

I asked if she felt thirsty or dehydrated and she said "very... I know I'm deyhdrated.  I'm prone to it"  so I suggested water.  Within 10 minutes she said she felt better, pain down to 2.  I suggested that she keep drinking and that this call was absolutely no substitute for a proper diagnosis.  She agreed and promised to see her Dr. and that she would call 911 if anything changed for the worst.  Besides dehydration, I also thought of anemia but I don't know a lot about how that presents.

Anyway, I never expected to be doing this kind of phone support.   "Hello, you have reached the EMT Hotline.   If your airway is open, clear and secure please press 1 now.  If you require suction, remain on the line and one of our Basics will be with you shortly"


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## reaper (Dec 9, 2009)

Good thing you DX her non cardiac problem by phone! You are almost ready for surgical rounds.


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## Simusid (Dec 9, 2009)

reaper said:


> Good thing you DX her non cardiac problem by phone! You are almost ready for surgical rounds.



I hope you also caught the part where I said "this call was absolutely no substitute for a proper diagnosis".   I made it very clear to her that this was nothing more than a best guess from 1200 miles away.


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## reaper (Dec 9, 2009)

She trusts you and took your opinion to heart.

Some advice I give all new EMT's. Never offer any kind of medical opinion or advice. Just tell them they need to see a Dr right away. Do not offer anything beyond that.

She heard dehydration and hooked on that. She is prime for cardiac issues and may not get it checked now.

Just a friendly word of advice.


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## spinnakr (Dec 9, 2009)

reaper said:


> She trusts you and took your opinion to heart.
> 
> Some advice I give all new EMT's. Never offer any kind of medical opinion or advice. Just tell them they need to see a Dr right away. Do not offer anything beyond that.
> 
> ...


I'm with reaper.  I mean sure, I'm the kind of person who helps out a friend with a twisted finger and stuff like that - but if it's at all serious, if there's ANY QUESTION, I'm going to tell them to go - or at least call their doctor.  And I never, _ever_ do *anything* except in person.  There are way too many variables here and I, quite frankly, don't trust the medical observation skills of someone who isn't medically trained, and who is very obviously distressed and may be highly biased to downplay the symptoms.  Witness how quickly she jumped on dehydration.

Given the facts of the situation - namely that this happened on the phone, from miles and miles away - I think telling her anything _but_ to call 9-1-1 was pretty reckless.  I'm not saying you couldn't have calmed her down first, but she needed to call.

Plus, think of it this way - what if she was _actually_ having an MI and lost consciousness?  Now there's nobody to call for help, and that phone call might be the last you ever hear from her.

On a side note, if the dehydration is enough to cause her N/V, I would encourage her to go to her doctor or the ED anyways.  At that point it's questionable if she'll be able to keep fluids down to rehydrate.  In other words, she might need an IV.


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## Lifeguards For Life (Dec 9, 2009)

nausea and vomting may very well be from swallowing blood from the nose bleed. nose bleed could be caused by dry membranes, trauma, nasal medications, hypertension among dozens of other ailments. hypertension being least likey as you have described orthostatic hypotension.

Dehydration is not most likely this patients primary problem. Chest pain, near syncope, Nausea and Vomiting and a spontaneuos nose bleed are not something that can be treated over the phone mate. next time this happens(which may very well be soon, since it is doubtfull your firend sought out medical attention after your phone call), she needs to call 911.


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## Seaglass (Dec 9, 2009)

Seconding all of the above. If they trust you, they don't really hear the "See a doctor--I'm just an EMT" bit. And those symptoms would be concerning to me... women often present with nausea/vomiting instead of the more usual symptoms when they're having cardiac problems.

Friends and family are hard to resist, though, especially when you know they can't afford anything and don't have insurance. Or when you know that saying "See a doctor" will mean you agree with their conviction that their little bugbite really is going to kill them, and they're going to use you telling them that as ammo in the next round of attention-seeking...


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## Lifeguards For Life (Dec 9, 2009)

Simusid said:


> This is more of a story than a scenario, so I guess it belongs here.
> 
> I have an online friend who I have never met.  I've known her for a few years and we know each other fairly well, and we communicate primarily via facebook.  We are 1200 miles apart but I was apparently the first person she thought of last night when she had a sudden onset of nausea/vomiting, nosebleed, and "chest pain".  She emailed me last night with a very urgent "am I having a heart attack?  should I call 911?  what do I do?"   She lives alone, is about 50 and this incident occurred while she was trying to get her car unstuck from a foot of snow in the midwest.
> 
> ...



chronic nosebleeds may cause a form of anemia, but anemia will not cause nosebleeds


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## VentMedic (Dec 9, 2009)

Lifeguards For Life said:


> chronic nosebleeds may cause a form of anemia, but anemia will not cause nosebleeds


 
That depends on the type of anemia.  There are way too many types to even begin to list here.  Different types of anemia have different causes and symptoms.


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## SanDiegoEmt7 (Dec 9, 2009)

Simusid said:


> Besides dehydration, I also *thought of anemia* but *I don't know a lot about how that presents*.



Hmmmm... interesting.  Sounds like she should have got a looksy from someone who could does.


The fact that you wasted time with her on the phone when she told you she was having chest pains, syncope, etc.  blows my mind.  You should have told her to call 911, or made the call yourself immediately.

Imagine if she hadn't been OK.


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## VentMedic (Dec 9, 2009)

Since this friendship has gone on for a few years, how much advice has the OP given out in the past?  

I guess his EMT instructor also forgot to tell him that MIs don't always present just like the textbook states especially for women, diabetics and the elderly.


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## Lifeguards For Life (Dec 9, 2009)

VentMedic said:


> That depends on the type of anemia.  There are way too many types to even begin to list here.  Different types of anemia have different causes and symptoms.



I know there are multiple types, but which type would cause epistaxis?


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## Lifeguards For Life (Dec 9, 2009)

VentMedic said:


> Since this friendship has gone on for a few years, how much advice has the OP given out in the past?
> 
> I guess his EMT instructor also forgot to tell him that MIs don't always present just like the textbook states especially for women, diabetics and the elderly.



you mean it's not ok to get medical advice from semi anonymous acquaintances met on online social networking websites:unsure:


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## VentMedic (Dec 9, 2009)

Lifeguards For Life said:


> I know there are multiple types, but which type would cause epistaxis?


 
Aplastic and Fanconi's are two I do know about very well.


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## Lifeguards For Life (Dec 9, 2009)

VentMedic said:


> Aplastic and Fanconi's are two I do know about very well.



thanks. i will try to look those up.


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## Simusid (Dec 10, 2009)

Original poster here again.   I've read everyone's reply and I really do appreciate all the comments.   I will take my lumps and admit that I should have ended the call with "you should call 911 now" rather than "you should call your doctor tomorrow" which is what I did and what she did.  

My role on the phone with her was to help her make sense of her situation, not to provide medical advice.  She and I both agreed on that.  You have all made it perfectly clear that it is hard if not impossible to separate the role of friend from that of an EMT.  And in hindsight, I agree with that too.

My takeaway from this is that the default answer is far far far more conservative than I would have expected.   Lesson learned.  Moving on.


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## VentMedic (Dec 10, 2009)

Simusid said:


> You have all made it perfectly clear that it is hard if not impossible to separate the role of friend from that of an EMT. And in hindsight, I agree with that too.


 
It is really not difficult at all.  You first must realize your own limitations.  In fact, it becomes easier after you advance your education to where you start to understand all the many different disease processes out there and the consequences bad advice can have on any of them.  You can often spot someone who is an EMT right away and even with Paramedics we'll hear from the patients that the "nice EMT(P) told me to do this" or "try that med instead because the meds I'm taking are all wrong for me".


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