Was it an MI?

[daedalus]

Ah, sorry, I was posting from class on my phone, I misread your post :]

I know you did, my comments where directed at the others here. you need no teaching.

 

[Mountain Res-Q]

Mean every word of it.

Based upon the post that prompted your comments... good for you... needed to be said. If I say something like that or make a joke about the an uneducated post then I get a "don't attack the uneducated" reply.

 

[silver]

As far as i remember ASA isn't in every SOG in CT for basic, and needs to be approved by Medical Director and/or the state. So that might explain why it was not used. However I dont really remember right now...

 

[spisco85]

I can not give Aspirin in our current protocols.

I also did not transport the patient because I first responded.

I did not have time to call med control because the ambulance showed up on scene while I was gathering a history and vital signs.

The patient took the nitro 30 minutes before he called 911. I do not know if the meds were expired.

I ran into the ambulance crew for that day and neither bothered to actually ask the medic what was going on.


Thanks for the replies guys and gals.

 

[Sasha]

I can not give Aspirin in our current protocols.

I also did not transport the patient because I first responded.

I did not have time to call med control because the ambulance showed up on scene while I was gathering a history and vital signs.

The patient took the nitro 30 minutes before he called 911. I do not know if the meds were expired.

I ran into the ambulance crew for that day and neither bothered to actually ask the medic what was going on.


Thanks for the replies guys and gals.

This has nothing to do with determining an MI but, if a patient takes or you give nitro, it's good to ask if they have a headache since it's one of the common side effects of taking nitro. If they didn't, the nitro could have been exposed to air or light for too long, expired, or otherwise ineffective. So next time that may be a question you can ask :]

 

[CAOX3]

Also you can ask for the burn under the tounge with sublingual administration.

Not every administration of nitro will be reflected in bood pressure readings it can also depend on the area of the infarct.

 

[MSDeltaFlt]

This has nothing to do with determining an MI but, if a patient takes or you give nitro, it's good to ask if they have a headache since it's one of the common side effects of taking nitro. If they didn't, the nitro could have been exposed to air or light for too long, expired, or otherwise ineffective. So next time that may be a question you can ask :]

The operative word here, hon, is yet. There are those with symptomatic chest pain that might not have any change in blood pressure or any other VS, deny HA, and still have unchanged symptomatic chest pain even after 3-4 doses of NTG that hasn't been exposed to light or air or expired or what-have-you. The pain just might be that severe and pronounced.

I'm sure you know this. I'm just making certain.

 

[Tal]

Nope. Bls volly service. I know without the 12 lead it is impossible to tell for sure.

I think that this kind of clinics, no matter if the pt 12 lead is clean or missing, will get the full protocol to MI.
nitro isnt the drug of choise, aspirin and MO for the pain.

 

[Ridryder911]

I think that this kind of clinics, no matter if the pt 12 lead is clean or missing, will get the full protocol to MI.
nitro isnt the drug of choise, aspirin and MO for the pain.

Explain why? Let's see crushing chest pain, hx of coronary occlusions and apparently Angina. So when would you give the NTG?.. You would immediately give Morphine? Hmmm..

Do you recognize what the rationale for NTG is for and how it works as well as the dangers associated with Morphine Sulfate (as in histamine responses)?

Again, don't be led like sheep...

R/r 911

 

[LAS46]

I think that this kind of clinics, no matter if the pt 12 lead is clean or missing, will get the full protocol to MI.
nitro isnt the drug of choise, aspirin and MO for the pain.

I am really not sure what school you are going to as a Paramedic Student but you are wrong about using MO or just plain ASA for a CP Pt. If I were you I would be checking into your local protocol and also asking your instructor for information on that. Nitro can only still be used if your Pt has a RX for it and Medical Direction (depending on you local protocol) gives you the Okay to use it.

________________________________
NTG Effects:
1. Relaxes blood vessels
2. Decreases workload of heart.

Morphine Effects:
Morphine effects include but are not limited to:

* relieves pain
* impairment of mental and physical performance
* relief of fear and anxiety
* euphoria
* decease in hunger
* inhibiting the cough reflex
___________________________________________

I think just by looking at this, it is clearly shown that NTG would be your proper drug of choice.

Dustin C.
MFR, NREMT-B Student
BLS/ALS Stroke Assessment and Treatment Certified.

 

[Tal]

Ridryder911 and LAS46

well,
the MDA protocol for chest pain that show nothing on a ECG but have the clinics of MI is:

Aspirin 200-300 mg
ECG
NTG
MO
Evac

in my post, I said that NTG isnt my drug of choise becuse of the pt B.P. in the short time that i was a first responder I saw how NTG effect quickly and drasticly on one's B.P.

I dont know how you work, I dont judge. evryone has his own methods etc. but when I treat a suspect MI pt with pains 8/10 I will give him MO to stop the pt's elephant pain, while treating the MI itself.

agian, in other codes i will use NTG, it not a drug that I dont acknowledge, but, in this specific code I will prefer not to.

hope I made my self clear-_-

 

[Aidey]

I'm not understanding why you wouldn't use Nitro in this setting. Without being able to examine the pt myself, I would say this pt is a prime candidate for nitro.

I personally don't like the spray nitro instead of the SL pills. I've seen pts spray it in their mouths like breath spray, rather than spraying it under the tongue.

In my protocols nitro taken PTA doesn't count towards the total dose we can give. Obviously it's BP dependant, but our MD feels that so many home nitro administrations are done with bad nitro, or taken the wrong way that we should take it with a grain of salt.

 

[CAOX3]

I'm not understanding why you wouldn't use Nitro in this setting. Without being able to examine the pt myself, I would say this pt is a prime candidate for nitro.

I personally don't like the spray nitro instead of the SL pills. I've seen pts spray it in their mouths like breath spray, rather than spraying it under the tongue.

In my protocols nitro taken PTA doesn't count towards the total dose we can give. Obviously it's BP dependant, but our MD feels that so many home nitro administrations are done with bad nitro, or taken the wrong way that we should take it with a grain of salt.

They spray it there eyes, they spray it on us. Not liking the spray nitro.

 

[EMTelite]

sounds like

Since this guy had, had MI's in the past then there is a good chance that this could be one although, depending on how long ago his MI's symptoms started the man should have started into cardiogenic shock which will in turn make the BP take a dump, this could be a possible case of an Angina if the attack did not happen to long ago.:unsure:

 

[rmellish]

Since this guy had, had MI's in the past then there is a good chance that this could be one although, depending on how long ago his MI's symptoms started the man should have started into cardiogenic shock which will in turn make the BP take a dump, this could be a possible case of an Angina if the attack did not happen to long ago.:unsure:

Short answer, no. An infarct will not always lead to cardiogenic shock. Depends on location and severity of the infarct. Hypertension is also common.

Angina is merely pain. The patient has angina. Technically the patient is complaining of angina pectoris, as angina is a general term for pain. The question is what has provoked this episode. The main concern is that this is a cardio-respiratory issue, possibly an MI.

Welcome to the forum by the way....we're all here to learn. I know I have.

 

[EMTelite]

Thanks

By the way thanks for the welcome... Ok so this patient is complaining of a severe chest pain which is angina pectoris... now when I am looking at an infarct why would I expect hypertension I am in no way questioning you I am just wondering where the cause of this is? Because when I have heard of a heart attack I have heard of vasodialation because the heart is trying to bring in more blood. But i have never really heard of hypertension after an MI? I have heard that Hypertension can lead to an MI but if you could give me a little insight to why hypertension would be a sign after a heart attack?

 

[rmellish]

By the way thanks for the welcome... Ok so this patient is complaining of a severe chest pain which is angina pectoris... now when I am looking at an infarct why would I expect hypertension I am in no way questioning you I am just wondering where the cause of this is? Because when I have heard of a heart attack I have heard of vasodialation because the heart is trying to bring in more blood. But i have never really heard of hypertension after an MI? I have heard that Hypertension can lead to an MI but if you could give me a little insight to why hypertension would be a sign after a heart attack?

Hypertension can be a sign of anything which stresses the body. Angina secondary to an infarct puts stress of the patient, causing hypertension. Hypertension would be more likely during an MI, rather than after the event. Hypertension alone is not enough to signify an infarct is occuring. It's certainly not that simple.

I may be treading a bit outside my understanding here, but typically hypotension presenting during an MI would be more likely to be caused by the location of the infarct (ie, anterior or inferior) affecting cardiac function, rather than an active compensation by the heart. :unsure:

I would assume the body would attempt to increase heart rate to compensate for the decrease in cardiac output if an infarct was causing a loss of function in certain areas of the heart.

 

[EMTelite]

yeah

Yeah now i am understanding what your saying... I was refering to hypotension during cardiogenic shock, but as you were saying for hypertension during the infarct

Maybe I stepped out of the conversation a bit much and just assumed the patient would be going into cardiogenic shock which is obviously not the case here beacuse we have a patient with obviously decent vital signs

But thanks now i got a little bit of a more firm look at an MI

 

[Aidey]

The patient may have also had high blood pressure prior to the cardiac event happening.

 

[EMTelite]

True

This could be the case because as said we are dealing with a patient that is 84 y/o so the possibility of High BP is very possible good point