Case- Chest Pain

[spenac]

Several times today.

I can assure you that it happens. This case is almost identical to one I had in February, vital signs and all.

In the band aid station we call ER they can not even find a manual cuff. Not to long ago I took a patient in either severally hypo- or hyper-tensive. Don't remember exactly. Got into the room patient was in bad shape had not responded to treatment in ambulance. Well the automatic BP showed severe opposite of what we got manually. The ER rent a-doc orders some drug to deal with what the machine said BP was. I on behalf of the patient spoke up and said Doc thats opposite of what we got both manually and with automatic cuff, wouldn't it be good to take a manual BP just in case. Surprisingly I was not removed from the ER and he said oh yea lets do that cause it's odd that it flip flopped. So off the nurses go looking for BP cuff. I finally just went got mine from ambulance and let the Doc take manual BP as nurses still had not made it back. Sure enough I was right. They never did find the manual BP cuff. Patient made it but would probably be dead if they had gone on automatic cuffs reading.

I like my auto cuff on stable patients, but I never treat based on it. If it shows something or if patient seems to have change in condition I get a manual BP to be sure. Just my half cent worth of thought.

[firemedic05]

One of the hardest concepts I had to tie my head around in medic school was not Pharmacology or Cardiology. It was that we don't diagnose but yet we have to diagnose in order to have a treatment plan. No medic would have this patient and come to the ER and tell the Doc this patient is having a dissecting Aortic aneurysm, they might say he/she is presenting with symptoms that mimic a AAA or dissecting aa and it needs to be ruled out. So, till we develop Xray vision, we are in essence guestimating what is wrong with the patient but using signs and symptoms to help. The main thing that I took from the case study is that the medic got the patient to the ER with a pulse. I and others, always want to expand our knowledge base but to get hung up on specific diagnosis is "futile". I had to find this out the hard way in the field. When I had a low blood sugar, decided to drive into tree but also decided to stroke and have a MI all at the same time. I looked at the Glucometer, the ECG, the Left sided facial drooping, had to trauma package --> I have to admit I was a little overwhelmed mentally. In the end, ABC's, spinal immobilization, treat shock, and the patient lived. No, pat on my back, the only thing I know I did right was turning a wheel and getting the patient to definitive care. So, in essence, what I am saying is it sounds like the treatment was appropriate and the learning the diagnosis let's the medic put it into his mental cue cards but next time it could be AAA. So suspicion was correct and best route if you ask me. Lovely debate and enjoy learning but no one is going to be correct all the time. Treat the patient, not the machines -->old saying but true.