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Issue link: https://emsworld.epubxp.com/i/131347
CASE REVIEW Case Discussion LEARNING POINT This case demonstrates the unusual presentations that are becoming common in patients suffering from acute ST segment-elevation myocardial infarctions (STEMIs). The occlusion of coronary arteries can come on suddenly or occur on and off for some time. This is sometimes called a "stuttering" onset of symptoms. It also happens frequently with patients having strokes, occlusions of blood vessels in the abdomen, and in some other, less common diseases. EMS personnel may encounter these patients during these periods and must rely on descriptions of patients' symptoms when they were at their worst for an idea of how serious they may be. It can also be hard to determine the exact time of onset of the disease if the patient has alternating periods of being ill and not ill. There are now many unusual clinical symptoms that can represent heart disease. Healthcare regions often have hospitals that serve as "centers of excellence," with greater capabilities to manage patients with heart disease, strokes, trauma, burns or specialty patients, such as pediatrics. Protocols for using these facilities as transport destinations are a key element of high-performance EMS systems and must be matched with a message for EMTs to communicate to patients. In trying to time the therapy for STEMIs or strokes, this uncertainty can be diffcult. Time of onset is usually easier to specify for trauma, burns, childbirth and other medical issues. This case also demonstrates the need to repeat a 12 lead EKG if the patient has a recurrence of symptoms, such as shortness of breath, pain or irregular heart beats. It may be the EKG that occurs with symptoms that gives the best information about the problem. This patient was taken to a hospital that had an interventional cardiac lab with which EMS personnel were familiar. The protocol at the hospital allowed for rapid movement through the ED and, as was demonstrated in this case, an opportunity to do a couple of key items before the EMS stretcher and personnel delivered the patient to the cath lab. A protocol like this must be approved in advance to be effective for the patient. James J. Augustine, MD, FACEP, is medical advisor for Washington Township Fire Department in the Dayton, OH, area. He is director of clinical operations at EMP Management in Canton, OH, a clinical associate professor in the Department of Emergency Medicine at Wright State University in Dayton, and an editorial advisory board member for EMS World. Contact him at jaugustine@emp.com. YOUR SOURCE FOR EMS SUPPLIES & EQUIPMENT • Full line EMS supplies & equipment ZOLL E-SERIES - REFURBISHED • Easy to use online shopping Biphasic, Pacing, SPO2, 12-Lead, NIBP, CO2, 12-month warranty • Fast reliable shipping 9,900 $ • New & refurbished equipment • Online customer support LIFEPAK 12 - REFURBISHED • Biomedical services Biphasic, Pacing, AED, SPO2, 12-Lead, NIBP, CO2, 12-month warranty ZOLL M-SERIES - REFURBISHED MEDSTORM BVM Biphasic, AED, Pacing, SPO2, 12-Lead, NIBP, 8,950 $ 12-month warranty 6,800 $ We repair and service medical equipment. Call to schedule an appointment today! 2460 Ash St. | Vista, CA 92081 | Tel: 800.764.0636 Shop online at www.progressivemed.com For More Information Circle 19 on Reader Service Card EMSWORLD.com | JUNE 2013 23