“Local Hosspital, this is Medic 7, local hospital, come in please.”
“Medic seven, go ahead.”
“Local Hospital, I have an ETA of approximately 10 minutes. This is a 56 year old female STEMI alert. He chief complaint is general malaise for several days. We have 4 millimeters of elevation in V1, 5 millimeters in V2, and 3 millimeters in V3. The rhythm is a sinus, at a rate of 65, without ectopy. Her blood pressure is normotensive, she has had her aspirin, and is receiving nitro every 4 minutes. I am transmitting her 12-lead now. We will see you in 10.”
“Medic seven, we’ll see you in 10. Local Hospital clear.”
This whole activating the cath lab from the field sounds great and all, but it doesn’t work when you have a doctor who thinks your job is to deliver his paycheck.
Neither myself, or my paramedic partner-of-the-day expected to find a STEMI on this lady, but we did. An anteroseptal one at that. So we did what paramedics do: we treated the patient.
We gave her aspirin, and we administered nitroglycerin. We performed serial 12-leads. Every 4 minutes, about 2 minutes after each nitro, I pressed the ’12-Lead’ button on our Lifepak 15. And I set up the automatic transmit option, so that Local Hospital received each 12-lead about 30 seconds after I did.
And what do you know. Her ST-segment returned to baseline. And what else do you know? Hotshot new doctor wouldn’t activate the cath lab. Because the last 12-lead showed no elevation.
Well, duh. I put a chemical band-aid on her, but now she might need some PCI.
“She doesn’t have any ST elevation now, so let’s put her in room 9.”
“She did have elevation, but you are right, she doesn’t have any now.”
“It’s not a STEMI.”
“It was a STEMI.”
“I’m the doctor, I know what I’m doing.”
“Then you should know what I was doing in the ambulance.”
“You were giving nitroglycerin to a patient without chest pain.”
“Nitroglycerin causes vasodilation, and reduces myocardial oxygen demand, which can help return an ST segment to the baseline, just like it did on her ECG. Y’all do PCI in the ER now?”
“She doesn’t need a cath.”
“She needs a cardiologist.”
“I will make that call.”
I never did find out what happened with that patient. I hope the hotshot doctor called cardiology. I won’t pretend to be a doctor, but I can prove the lady was having a STEMI.
She’s hotshot’s patient now.