Angina Pectoris vs Myocardial Infarction

daedalus said:
Hi Melcin,

No, the differences between angina and MI are not taught to United States EMT students. Sad, huh?
In the summer EMT-B class I just took, we were taught the difference. the class is always evolving and I think the fall class are learning more.

That's why I keep going to class!
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The only thing I have to say its that the majority of you need to go back to school and take a course of literature comprehension and listening skills you ripped a part this fellow for just a simple question.......

whats the difference between Angina Pectoris vs Myocardial Infarction... is a simple question on the different sings and symptoms between each other.....

we as emt-b we do not diagnose and emt-p could tell by reading the result on the way to the hospital but you can not tell the difference by the naked eye per say you rely on your S.A.M.P.L.E. History so you can suspect but again our job is to treat not to diagnose the problem.... A few said you can take some classes like A.C.L.S etc.... I am still a student, ill ask, we have a few instructors that are EMT-P and EMT-I but I dought you can just tell if the Patient doesnt tell you specifics.
by the way i read the chapter Cardiac Emergencies before i posted this, it only tells what and why was caused and they do teach us the difference between one and another!!!

Again I think most of you need to READ the question, AND JUST ANSWER THE F**** QUESTION
 
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White Fang said:
The only thing I have to say its that the majority of you need to go back to school and take a course of literature comprehension and listening skills you ripped a part this fellow for just a simple question.......

whats the difference between Angina Pectoris vs Myocardial Infarction... is a simple question on the different sings and symptoms between each other.....

we as emt-b we do not diagnose and emt-p could tell by reading the result on the way to the hospital but you can not tell the difference by the naked eye per say you rely on your S.A.M.P.L.E. History so you can suspect but again our job is to treat not to diagnose the problem.... A few said you can take some classes like A.C.L.S etc.... I am still a student, ill ask, we have a few instructors that are EMT-P and EMT-I but I dought you can just tell if the Patient doesnt tell you specifics.
by the way i read the chapter Cardiac Emergencies before i posted this, it only tells what and why was caused and they do teach us the difference between one and another!!!

Again I think most of you need to READ the question, AND JUST ANSWER THE F**** QUESTION
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First of all, how is it my job to treat but not diagnose? How does one go about doing that? Do you know what SOAP is? You need to form an assessment of a patient before moving to the treatment plan.

Second of all, the attitude is just rude.
 
White Fang said:
we as emt-b we do not diagnose
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You're wrong. Read page one of this thread to find out why. On your way through, please note the numerous people who answered the original poster's question regarding MIs and angina.
 
The responders that scare me aren't the ones that come to places like this and ask questions. The ones that scare me are the ones that just assume they know it once they graduate and aren't curious enough to look into what they don't know.

daedalus said:
No, the differences between angina and MI are not taught to United States EMT students. Sad, huh?
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My class covered it pretty extensively, but I've run into some that didn't. I even recently encountered a graduating first responder class in a scenario where everyone though my circumferential burn around the wrist was a low-priority transport, and the soot around my mouth was just a distraction from the real injury. The lack of education some emergency workers has is really quite frightening.

OP: As a student, you're likely to eventually run into topics in the field that just weren't covered in your class, or that were covered too briefly to be of any use. If you had a good textbook, crack it open occasionally and review. If you didn't or want more detail, places like this are great. :)
 
White Fang said:
The only thing I have to say its that the majority of you need to go back to school and take a course of literature comprehension and listening skills you ripped a part this fellow for just a simple question.......

whats the difference between Angina Pectoris vs Myocardial Infarction... is a simple question on the different sings and symptoms between each other.....

we as emt-b we do not diagnose and emt-p could tell by reading the result on the way to the hospital but you can not tell the difference by the naked eye per say you rely on your S.A.M.P.L.E. History so you can suspect but again our job is to treat not to diagnose the problem.... A few said you can take some classes like A.C.L.S etc.... I am still a student, ill ask, we have a few instructors that are EMT-P and EMT-I but I dought you can just tell if the Patient doesnt tell you specifics.
by the way i read the chapter Cardiac Emergencies before i posted this, it only tells what and why was caused and they do teach us the difference between one and another!!!

Again I think most of you need to READ the question, AND JUST ANSWER THE F**** QUESTION
Click to expand...

If you only treat and do not diagnose, then you are treating with no idea why. if you don't diagnose before you treat, then you are just randomly performing interventions?
 
daedalus said:
First of all, how is it my job to treat but not diagnose? How does one go about doing that? Do you know what SOAP is? You need to form an assessment of a patient before moving to the treatment plan.

Second of all, the attitude is just rude.
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JPINFV said:
You're wrong. Read page one of this thread to find out why. On your way through, please note the numerous people who answered the original poster's question regarding MIs and angina.
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Lifeguards For Life said:
If you only treat and do not diagnose, then you are treating with no idea why. if you don't diagnose before you treat, then you are just randomly performing interventions?
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Well I know this I will be soon an EMT B and my job is to TREAT SIGNS AND SYMPTOMS!!! not diagnose so if you are a EMT I or medic thats a diferent story!

well all i can say is one thing that this is the worst of all forums that I been through and you should just read this annoucement...
http://www.emtlife.com/showthread.php?t=14470

good luck!
 
Disagree!=flaming?

...and if you're "soon an EMT-B," why do you list your training level as "EMT-B?" Shouldn't it be "student?"
 
Whitefang,

You get called out to a "leg pain" call at the local soccer field where a player was kicked in the shin. Upon arrival, you see bone protruding out of the players shin.



Is that a break?



Careful! If you call it a break, you're diagnosing something!
 
If you give me epi as an EMTB, have you diagnosed me as havin anaphylaxis, or are you just giving me epi blindly?
 
If it were me, I'd be giving it because it looked cool.
 
All very good points! However, on the point of the EMTs job not to diagnose... the reality is with a patient experiencing stable angina that resolves with rest and Nitro you would not need to transport. Therefore in this case, an EMT does need to come up with a Differential. It is true that when in question treat all cardiac events as worst case scenario (A.M.I) with an ALS response.
 
Melclin said:
PLUS ONE TO JPINFV

Sugi,

TONED OUT : 3:23PM 47 Female - Trauma; Extremity.

You're pt's foot really hurts. BLS job right? Nothing to worry about? Why does education make a difference?

She a bit pale when you get there and she's got new pit stains. Her face is dry but you notice a hankerchief in her hand. With some further questioning, she turns out to be a diabetic. Her BP is 130/90 thats within the limits of normal for the Idiot's guide to EMT-Basic book right? Still a BLS job?

This is a real case by the way. Luckily the basic here have a much better education and some good tools. Luckily they saw this for what it was and had ALS back up role L/S which was a good thing too because she arrested halfway to an appropriate PCI hospital. She lived (ALS got her back and rolled straight into the cath lab because we're cool like that B) ), but you have to wonder if she would have, if her BLS provider had simply said, "oh toe pain, I'll sit here and spinal immobilize her because protocol says it was given as trauma" and generally pis about because its just a sore leg and you don't need an education to drive people to hospital.

If you believe in good pt care, you will make the effort to go above and beyond the scope of you EMT education.
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ok, so what was going on? first off, I can think of several things wrong with your scenario:

1) why would you spinal immobilize toe pain? I might not be a paramedic student, but I am pretty sure the toe is several feet from the spine. it's about as absurd as spinal immobilizing someone with a traumatic injury to a finger. but again, I am not a paramedic student, so I might need to review my A&P to confirm

2) did she hurt her foot? as it, did the patient have her toe stepped on? was it a traumatic foot injury? or a sudden onset of pain with no history and no known cause? big difference in what I would be thinking as the cause

3) you say her face is dry, what about her chest? is she grossly diaphoretic in her chest, and been drying her face for the past hour? and what is her pulse rate, and the quality? you aren't giving enough information about your assessment (yes, BLS are still supposed to do physical assessments) to determine if the patient should go ALS or BLS.

4) lets say it was a traumatic toe injury, did the injury cause the cardiac arrest, or was it just good luck that she arrested in the ambulance?

btw, from this uneducated opinion, based on the very poor assessment you did (because you are missing several key factors about the patient's condition), I would guess that the patient suffered a PE, and by bad luck it made its way to her heart. Based on the limited info you provided it sounds like a BLS call (again, you are missing several key factors in your assessment so it's a rough guess), and by dumb luck she arrested. she could have very easily made it to the hospital not in cardiac arrest. so what was the underlying cause?

back to the OT, angina vs MI is still chest pain to the EMT. Should they know the difference? probably. should they treat them the same? well, without further tools to properly assess, probably, they should treat it as a chest pain, and call for ALS.
 
dave3189 said:
the reality is with a patient experiencing stable angina that resolves with rest and Nitro you would not need to transport.
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You should ALWAYS try to transport cardiac problems. How are you able to tell the difference between stable angina and Prinzemetals angina, which is a precursor to sudden death, in the field? You aren't. If it turns out to be Prinzmetals, they need to see a cardiologist asap.
 
DrParasite said:
ok, so what was going on? first off, I can think of several things wrong with your scenario:

1) why would you spinal immobilize toe pain? I might not be a paramedic student, but I am pretty sure the toe is several feet from the spine. it's about as absurd as spinal immobilizing someone with a traumatic injury to a finger. but again, I am not a paramedic student, so I might need to review my A&P to confirm

Of course you wouldn't immobilize this pt. I was using the ridiculous use of spinal immobilization in some parts of America as a sarcastic example to make a point about education.

2) did she hurt her foot? as it, did the patient have her toe stepped on? was it a traumatic foot injury? or a sudden onset of pain with no history and no known cause? big difference in what I would be thinking as the cause

No she didn't. It was referred pain from her MI. The fact that she was a diabetic makes atypical presentations more likely.

3) you say her face is dry, what about her chest? is she grossly diaphoretic in her chest, and been drying her face for the past hour? and what is her pulse rate, and the quality? you aren't giving enough information about your assessment (yes, BLS are still supposed to do physical assessments) to determine if the patient should go ALS or BLS.

I wasn't presenting it as a scenario to actually be 'worked' by people in the thread. It was an example to highlight the importance of education to better standards of care.

4) lets say it was a traumatic toe injury, did the injury cause the cardiac arrest, or was it just good luck that she arrested in the ambulance?

Silent/atypical presentation for AMI which she then arrested from slightly later down the track.

btw, from this uneducated opinion, based on the very poor assessment you did (because you are missing several key factors about the patient's condition), I would guess that the patient suffered a PE, and by bad luck it made its way to her heart. Based on the limited info you provided it sounds like a BLS call (again, you are missing several key factors in your assessment so it's a rough guess), and by dumb luck she arrested. she could have very easily made it to the hospital not in cardiac arrest. so what was the underlying cause?

It was never "my" patient assessment, and as I said, I wasn't actually providing a fleshed out scenario, just an example to highlight my point. The fact that, even from the small amount of information I gave, you have drawn the conclusion that it was still a BLS job and dumb luck that she arrested, is more evidence to my argument for education - my point was that many basics do not have the education to really identify when they are out of their depth, and you've just proved it.

Speaking of education, how exactly would a PE 'make its way to her heart'? You are talking about a pulmonary embolism aren't you? Explain to me how that happens.


back to the OT, angina vs MI is still chest pain to the EMT. Should they know the difference? probably. should they treat them the same? well, without further tools to properly assess, probably, they should treat it as a chest pain, and call for ALS.
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EDIT: and now we have a Basic saying they don't necessarily need to transport these patients...you sure as hell wanna know what you're talking about if you think you are going to not transport patients with an obvious cardiac problem and history.
 
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If the Angina occurred during exercise or exertion and not at night for example, and the symptoms resolved with rest and nitro prior to your arrival you would not have to necessarily transport... IE: If there is no indication that the angina is unstable or the s/s indicate something more such as an M.I. Patients with stable angina would be taking quite a few rides to the E.R. if they went every time they had an episode. The patient's opinion as to whether this was a typical episode of "stable" angina for them would be key in making such a decision.
 
dave3189 said:
If the Angina occurred during exercise or exertion and not at night for example, and the symptoms resolved with rest and nitro prior to your arrival you would not have to necessarily transport... IE: If there is no indication that the angina is unstable or the s/s indicate something more such as an M.I. Patients with stable angina would be taking quite a few rides to the E.R. if they went every time they had an episode. The patient's opinion as to whether this was a typical episode of "stable" angina for them would be key in making such a decision.
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Again, how are you as a basic able to differentiate between stable angina and Prinzmetals by history alone? You aren't, especially once a vasodialator such as nitro or morphine is administered. A 12-lead needs to be done before any determination is made... and even then you should try to get your pt to go to the hospital.
 
Prinzemetals Angina typically occurs at rest, unlike the more typical presentation where it occurs during one of the "E's". That being said, I agree with you that you are basing this off of a focused history. You have given me something to think about and to research into my local protocols. I am certainly willing to admit when I'm wrong, and freely admit that I am in an infant stage in my EMS career. Thanks for the insight!
 
Also remember to ask "why did you call 911 today?" People with stable angina, who get a little out of breath and take their nitro usually aren't calling 911. The fact that you were called means that someone (the patient, the family etc) thought what was going on today was different or worse than usual. That fact alone justifies a transport.
 
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