Survey Uncovers Deficiencies in Heart Attack Care

Isnt that the norm today?

This has been the norm around here for years, we are not exactly the most progressive system. STEMI is an automatic cath lab notification for our ALS providers.
 
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doing a 12 lead does not delay transport. Its a 30 second procedure. We can take the patient directly to the cath lab.
 
downunderwunda said:
Which ones am I going to kill a patient if i dont do anything but ASA, Nitro, O2 & morphine? I can & have had chet pain patients in my care for up to an hour, with multiple dysrhtmias & havent lost one yet, so please tell me, which ones?
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V-Tach....SVT.....etc
 
PSVT, Vtach, Afib with RVR, runs of PVC's, RVF,STEMI!!!!!!!!!!!!!!!!1
 
reaper said:
PSVT, Vtach, Afib with RVR, runs of PVC's, RVF,STEMI!!!!!!!!!!!!!!!!1
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reaper,

i have transported people with what you are describing with no interventions & surprise surprise, they lived.

So I will ask again, which ones, left untreated for the 1 hour transport times will be fatal, aside from VT, VF, asystole pulsless bradycardia etc?
 
downunderwunda said:
reaper,

i have transported people with what you are describing with no interventions & surprise surprise, they lived.

So I will ask again, which ones, left untreated for the 1 hour transport times will be fatal, aside from VT, VF, asystole pulsless bradycardia etc?
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So you are saying that you are a sub par medic?

If you take a pt with PSVT at a rate of 190 or an Afib pt with a rate of 240 and did not treat them for an hour transport, then that is sub par medicine.

I work a service that has thrombolytics for long transports. They are rarely used, as the cath labs do not like them being used.

We also administer Heparin for any active STEMI and Lopressor for any STEMI with out Right side involvement. Neither of these can be used without a 12 lead to confirm ST elevation.

Treating a chest pain pt is not easy as cake, in the real world. We use medicine to help our pt's. Not drive them in, while they suffer more pain and lost cardiac muscle!
 
downunderwunda said:
reaper,

i have transported people with what you are describing with no interventions & surprise surprise, they lived.

So I will ask again, which ones, left untreated for the 1 hour transport times will be fatal, aside from VT, VF, asystole pulsless bradycardia etc?
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They all can be.

A-fib with new onset can quickly lead to decompensation depending on medical history. As well, A-fib is very dangerous due to clots. If the person cannot be converted quickly, they will need anti-coagulants.

STEMI? That depends on how much of the heart muscle is affected and whether they can maintain cardiac output or if they just throw a lethal arrhythmia to be dead before they hit the floor. It is not uncommon to lose a STEMI within the first 30 minutes.

Right ventricular failure can carry a worse prognosis than left ventricular failure.

PSVT: It all depends on how well the body can withstand sudden hemodynamic changes.

Too many in EMS want a blanket statement made for every medical condition. Since every patient is different, to count on that blanket statement is playing Russian Roulette with someone's life.

Any factor that gives rise to hemodynamic instability has potential to be fatal. Thus, the importance of "ALS" is to maintain hemodynamic stability. The sooner one is aware of any factor for instability, the better prepared one is to gain control and prevent that patient from coding.

How you ever gone back to the ED to see how many of your patients lived for 24 hours after you dropped them off? The "normal" vitals thing means very little when a person is in the compensatory phase. Read the shock thread.
 
Ridryder911 said:
Only end of the story is your lacking in education of cardiology and the understanding of emergency and critical care. What limitations? What can they do in the ER, that I can't? Still await for a cath team to get ready?

Do you understand right sided AMI, bifascicular and trifascicular blocks and the associated increase morbidity with the use of Morphine? Or should we have the idea to just run "r-e-a-l fast" to the hospital. The only limitations one can have is limiting one's mind. I have been performing twelve lead prehospital for over 20+ years and in some rural areas thrombolytics. Even used non-portable type ran through a converter and faxed to a cardiologist in a very rural area, so yes it can be done.

Sure one can await for a twelve lead in ER. Then await for consultation with a cardiologist. Then await for the cath lab to be notified.... Nice move slick, you just increased the time and possibly help increase the AMI size or even increasing the chance of morbidity. All of this could had been prevented per performing a twelve lead and alerting the ER and possibly cath lab.

It's 2009, come up to par...

That is the end of the story.
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No it isnt rid.

First, let me ask you to remove yr head from where the sun dont shine.

Yes i will get another warning for that i am sure.

I transport for up to & over 2 hours. The nearest available cath lab, if attended onthe day is a further 2 hours from there, alternativley we travel 4 hours in the other direction.

Oddly enough, through prudent use of the drugs we have, through the education we have (which MUST be deficient to your as we are not american (I feel yet another warning for that one), we still manage to get our patients to the cath labs, with little or no further damage than was caused by their delays in calling us.

Yes it is 2009. However, regardless of what is said, the only true & difinitive care for any patient whith ANY cardiac complaint is not in an ambulance but in a hospital.

That my friend is the end of the story.
 
Amazing, to acclaim to know and yet represent ignorance. I have discussed care with medics from Australia and was impressed with their knowledge base as well as aggressive treatment in some areas. You are the first one that I have seen that has represented such unknowing knowledge of the results of myocardial ischemia, infarction.

No one an EMS unit is the most definitve care. Performing a 12 lead was never assumed to do such; rather an assessment tool.

You may have acclaim to have transported without incidence and that is probably by the Grace of God.

I really suggest that you read not only American studies but International ones (I am sure that they have similar in Aussie land as well) and doubtful any describe to defer from good assessment techniques or delay in cath care. Please produce information that these "wonder drugs" you or local ER's prevent myocardial injuries. I am sure the rest of the world would like to see as well. That is if you can produce such; otherwise you are spouting from down under.

R/r 911
 
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EMS needs to grow to actually performing medicine not being a horizontal taxi.
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I agree to an extent, but at the end of the day we do in fact bring patients to the hospital. If we want to be able to claim that our core is not transportation, but medicine, we have to have the education and ability to treat and release (not relevant to this thread).
 
daedalus said:
I agree to an extent, but at the end of the day we do in fact bring patients to the hospital. If we want to be able to claim that our core is not transportation, but medicine, we have to have the education and ability to treat and release (not relevant to this thread).
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Yes we treat and release. We educate the public. We deny transport. We focus on medicine not on driving ever caller where they want to go. If they need to go we take them while performing medical interventions.
 
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