Take Nothing For Granted.

ArcticKat

ArcticKat

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So, 2230 last night we get called out for an attempted suicide in a remote rural area. We arrive to two police who inform us that the client left the scene in her car prior to their arrival. She had been arguing on the phone with her hubby and told him she was gonna do herself in by taking an overdose. A search begins for her and her car over the next 2 and a half hours.

As we search, hubby drives up...he'd been headed to a conference and turned around. We talk to him for a bit and he says "Ya know, my chest is feeling a little sore." So we chat him up and start evaluating him. Stent insertion 5 years ago and diabetic history. Vitals are all fine, 12 lead is unremarkable and we start leaning towards anxiety attack because of the situation with his wife. Just one last check I obtain a cTnI and myoglobin sample at the same time as his BGL. (23.3 Mmol/L or 420 mg/dl)

Myoglobin and cTnI both pop positive on the blood test. Off to the cath lab for a NSTEMI.

Edit: Wife turned up at 0030, lucid and having not ingested any harmful substances, escorted to the hospital by police.
 
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Wow, never know What you are going to get on a call.B)
 
ArcticKat said:
So, 2230 last night we get called out for an attempted suicide in a remote rural area. We arrive to two police who inform us that the client left the scene in her car prior to their arrival. She had been arguing on the phone with her hubby and told him she was gonna do herself in by taking an overdose. A search begins for her and her car over the next 2 and a half hours.

As we search, hubby drives up...he'd been headed to a conference and turned around. We talk to him for a bit and he says "Ya know, my chest is feeling a little sore." So we chat him up and start evaluating him. Stent insertion 5 years ago and diabetic history. Vitals are all fine, 12 lead is unremarkable and we start leaning towards anxiety attack because of the situation with his wife. Just one last check I obtain a cTnI and myoglobin sample at the same time as his BGL. (23.3 Mmol/L or 420 mg/dl)

Myoglobin and cTnI both pop positive on the blood test. Off to the cath lab for a NSTEMI.

Edit: Wife turned up at 0030, lucid and having not ingested any harmful substances, escorted to the hospital by police.
Click to expand...

This is great that you all can test for cardiac enzymes prehospital. We don't have one in our system. What manufacturer do you use for the device? Also how much time does it take the device to display results? Sometimes we are close to the hospital and running this wouldn't make since. When we are 15-20 minutes out, it makes alot of since.
 
We get the tests from here:
www.tntdiagnostics.com

They're about 18 bucks each, don't need to be refrigerated, and have a shelf life of about 18 months.

Here's a video:
http://www.youtube.com/watch?v=gK_xCL8XcUI

The test can have results in as quickly as a couple of minutes, depending on the strength of the enzyme. The results aren't supposed to be used if they appear beyond 20 minutes though.
 
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For an NSTEMI, I wonder if the QTc would be prolonged?
 
ArcticKat said:
So, 2230 last night we get called out for an attempted suicide in a remote rural area. We arrive to two police who inform us that the client left the scene in her car prior to their arrival. She had been arguing on the phone with her hubby and told him she was gonna do herself in by taking an overdose. A search begins for her and her car over the next 2 and a half hours.

As we search, hubby drives up...he'd been headed to a conference and turned around. We talk to him for a bit and he says "Ya know, my chest is feeling a little sore." So we chat him up and start evaluating him. Stent insertion 5 years ago and diabetic history. Vitals are all fine, 12 lead is unremarkable and we start leaning towards anxiety attack because of the situation with his wife. Just one last check I obtain a cTnI and myoglobin sample at the same time as his BGL. (23.3 Mmol/L or 420 mg/dl)

Myoglobin and cTnI both pop positive on the blood test. Off to the cath lab for a NSTEMI.

Edit: Wife turned up at 0030, lucid and having not ingested any harmful substances, escorted to the hospital by police.
Click to expand...

Interesting call. Could you expand on what made you lean more towards anxiety rather than ACS? In someone with a cardiac history and diabetes, it seems like there should be a very high index of suspicion for something cardiac with any kind of chest discomfort. (I know this is easy for me to say being on a forum and after the fact, which is why I'm curious to understand your decision making at the time better.)
 
The fact that he had just been fighting with his wife who had threatened to commit suicide and then disappeared. I empathised with him and figured I'd be pretty anxious in this situation too. With all V/S normal and no indications on the ECG of a cardiac event we were beginning to consider other options. Did we rule out NSTEMI? No, but without the blood test we'd exhausted all of our diagnostic tools to confirm a cardiac problem and had to keep ourselves open to other possibilities rather than have tunnel vision on just that one.

Considering the cardiac history I would have transported him to the local base hospital and treated him conservatively with O2, ASA, and Nitro. With the blood test it was to the Cath Lab, Plavix and Lovenox, saving him about 2 hours.
 
Those test devices are pretty cool. I might drop a word in our Ops Manager's ear about it and see if it might be something we can get... since even our basics can test CBG, I don't see why the state would have an issue with our Is/Ps doing this. Our shortest transport time is 20-25 minutes so they could come in handy
 
Anxiety versus angina (alliterative, no?)

Can be both. Good and lucky call.
 
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