Last time I checked panic attacks were a pretty legit medical issue, funny you don't seem to put them in that category.
No one is saying write it off. But evaluating risk factors is a big part of medicine.
Chest pain
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No one is saying write it off. But evaluating risk factors is a big part of medicine.
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Outside of calming/coaching and potentially benzos in really severe cases there's not much EMS is going to do for anxiety or a panic attack.
But with that said what does EMS do for most things?
Definitely is a real medical issue though, no one can argue against that.
But with that said what does EMS do for most things?
Definitely is a real medical issue though, no one can argue against that.
Shishkabob
Forum Chief
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Naw, it goes on long enough, they'll pass out and fix themselves. Save the paperwork from using controlled substances.
PS, if you ever want to scare a firefighter, do exactly that: Get an un-coachable anxiety patient, sit there just looking at them and wait for them to pass out.
h34r:- 9,736
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Naw, it goes on long enough, they'll pass out and fix themselves. Save the paperwork from using controlled substances.
PS, if you ever want to scare a firefighter, do exactly that: Get an un-coachable anxiety patient, sit there just looking at them and wait for them to pass out.
:rofl:
I know they'll do it but I've never seen someone bad enough to. Always been able to coach them down. Never given benzos for anxiety either but can do it under standing orders. I like your way better. Fire here would WIG!
Shishkabob
Forum Chief
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I've done it and it is rather funny.
Fire: Aren't you going to do something?
Me: No
Fire: But they can't breathe
Me: Eh, they'll pass out soon
Fire: WHAT?!
Disclaimer: I myself have had a panic attack with air trapping. It sucks. But hey, it is what it is.
Fire: Aren't you going to do something?
Me: No
Fire: But they can't breathe
Me: Eh, they'll pass out soon
Fire: WHAT?!
Disclaimer: I myself have had a panic attack with air trapping. It sucks. But hey, it is what it is.
DrParasite
The fire extinguisher is not just for show
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12 lead, transport to cath lab, STEMI alert. treat with NTG, ASA, and ensure the cardiologist is waiting for you when you cross the doors.
Nah, I would actually walk the patient to the ambulance, sit her on the bench, and transport her to local ER.
And RRob's right, under 35 with chest pain and normal breathing would get coded by EMDs as a Priority 3 call.
Nah, I would actually walk the patient to the ambulance, sit her on the bench, and transport her to local ER.
And RRob's right, under 35 with chest pain and normal breathing would get coded by EMDs as a Priority 3 call.
abckidsmom
Dances with Patients
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DrParasite
The fire extinguisher is not just for show
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it happens once in a while.
Priority Dispatch EMD makes it a required question and results in numerous unnecessary upgrades. i didn't make the system, my boss just requires that i use it.
Priority Dispatch EMD makes it a required question and results in numerous unnecessary upgrades. i didn't make the system, my boss just requires that i use it.
Shishkabob
Forum Chief
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"No she's not breathing normally, that's why I called you! Why aren't you sending the amberlamps?!"
abckidsmom
Dances with Patients
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I strongly, strongly agree with everything about MPDS. I think their method is the best one out there, and when stupid people call 911, you'll get that every time. A necessary evil, I think.
I like how they don't allow dispatcher-driven downgrades. Too many crispy people out there would mess that up.
Clare
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MPDS is what we use and is pretty good, having recently gone through a huge review where every single possible detriment has been reviewed and assigned a classification depending upon how time critical the problem is and how much of a threat it presents to the patients life so a lot of the old stuff that used to automatically be a priority one eg had seized but no longer fitting is now normal road speed, also things like cuts and flu and abdominal pain gets the Sierra jeep or phone advice instead of an ambulance.
Instead of being sent willy nilly to absolute BS on a one the new model means that things on a one are immediately life threatening or time critical.
Christopher
Forum Deputy Chief
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Had a 15yo thrown from a horse, and out of blind habit placed them on the monitor....only to find a previously undiagnosed congenital complete heart block requiring pacemaker implantation. Dumb luck saves the day.
I respectfully requested they take up riding Zebras to help out future paramedics.
Glucatron
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At 17, MI is extremely unlikely but I wouldn't throw it out completely. I would separate her from the mother and gather as much history as I could. Is she on BC? What has been going on in her life? Has she taken any drugs? It could be a caffeine thing. Anxiety is certainly high on the list. ASA, I might give, age isn't a contraindication. I would explore the pain and see if I can get an honest answer on what hurts, how it hurts, etc... What physical condition is she in? Is she obese? Does she have any medical history. That would be a tough one for me, too. Especially if she is presenting with classic MI symptoms. Anxiety really can mimic a cardiac emergency. The patient is already panicking and then their own physical reactions can panic them more.
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Glucatron
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I am not sure I would give ASA but I might if she is presenting with symptoms of an MI. I would consider that as a possibility. I guess what I mean is that it wouldn't be wrong to give ASA if the EMT suspected an MI. ECG is showing sinus tach at 102 so I'm guessing the medic isn't that worried. There would need to be a more detailed examination like if it hurt more if you press on the chest, visually inspecting the area and medical history but she is exhibiting symptoms typically associated with an MI. Whether it's caused by an undiagnosed heart defect or maybe the patient was very sedentary and a clot in the leg broke off. One of the medics I worked with had an 18 year old patient who was played video games chronically and had an MI. The blood pressure would lesson any suspicion because if there was a cardiac issue the vessels would constrict to compensate. I'm going to say my main reason for giving ASA, if I chose to, would be that the MI is one of my differential diagnoses supported by her signs and symptoms (diaphoresis, chest pain and shooting pain in the arm).
Melclin
Forum Deputy Chief
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Was SSRI withdrawal or discontinuation considered? The nature of that particular problem is controversial, but there is some suggestion that "electric shock" type symptoms as well as other less descript things.. nausea.. diaphoresis... I think.
Maybe an atypical description of precordial catch syndrome, costocondritis or tietse syndrome. The suggestion that its common but never this bad points me in this direction. Asking for a little clarity with the pts description or asking the same few questions in different ways could provide a lot of clarity here.
I'd be almost certain that its a mostly benign condition.
Really? So if a person was tachycardic and you ask you partner to whack the monitor on while you chat to the pt and at the end of the exam you decide that the pt's condition if totally benign....you can't take the monitor off and you have to transport? Is that by convention or by protocol?
I find that interesting but quite odd to be honest.
Maybe an atypical description of precordial catch syndrome, costocondritis or tietse syndrome. The suggestion that its common but never this bad points me in this direction. Asking for a little clarity with the pts description or asking the same few questions in different ways could provide a lot of clarity here.
I'd be almost certain that its a mostly benign condition.
Really? So if a person was tachycardic and you ask you partner to whack the monitor on while you chat to the pt and at the end of the exam you decide that the pt's condition if totally benign....you can't take the monitor off and you have to transport? Is that by convention or by protocol?
I find that interesting but quite odd to be honest.
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At the risk of sounding BLS. Treat your patient , Not your monoitor.
Sounds like anxiety and the cynic in me says possible drug/attention seaker.
I would start with calming techniques maybe oxygen, or even a saline neb! ( i've had it fool "Drug Seekers" into thinking they were getting a special new drug. and calms some axiety pts down. Coaching her breathing as well.. All that can be done as you complete your primary assesment, ecg and vitals.
Sounds like anxiety and the cynic in me says possible drug/attention seaker.
I would start with calming techniques maybe oxygen, or even a saline neb! ( i've had it fool "Drug Seekers" into thinking they were getting a special new drug. and calms some axiety pts down. Coaching her breathing as well.. All that can be done as you complete your primary assesment, ecg and vitals.
NomadicMedic
I know a guy who knows a guy.
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I certainly don't thinking bragging about "tricking your patient" is the best way to frame up your argument as a skilled clinician. In other words, ethically... It's wrong.
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Facepalm
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We don't have a written protocol about it but the thought of QA/QI is "if you were suspicious enough to use the monitor you need to ride in with the patient."
Not saying it is or isn't right, that's just how it is here. Every ambulance is ALS so it's not taking two resources out of service to transport that patient with an ALS provider attending.