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A Tale from an ER & a Night at Daily Kos

First, I want to say how happy I am that our sister, BoiseBlue is home recovering and was just suffering from dehydration post extensive oral surgery. If anyone thinks that dehydration is not an emergency, let me assure you it is and needs to be treated properly and promptly.

I also want to thank one persistent retired Paramedic, Thinking Fella. You are the epitome of what every Paramedic should be. Suspicious and Persistent and Innovative. It is an understatement to say that you did a great job last night.

BoiseBlue's instinct to come to us for advice was a good idea and had a happy ending. Thank you all for keeping that diary on the recommended list and for the kind words you gave her, as well as, the support you gave to Thinking Fella. Well Done by all.

That said I have a short story about a patient and a paramedic. It's a true story about "I don't feel well. Is this normal?"

No, it wasn't "normal" and it was life threatening.

There have been several people who have said they were going to print this dairy. Click here for the printable page
h/t Pluto

One of the medics that worked for us brought a man in his mid 40's to the ER, His chief complaint was pain in his left knee that was excruciating but no injury and he had hiccups that started after the pain in his knee started. Both symptoms started while he was watching basketball on TV.

The pain and hiccups persisted and the hiccups were were painful. So the patient call 911 for advice. The 911 operator referred his call to an EMS call operator to get his info while sending an ambulance to the address. The EMS operator is an EMT in NYC and was suspicious because of the painful hiccups. So he upgraded the call to a "Cardiac Condition" and had a Paramedic Unit sent.

The Paramedic Unit that night was staffed with one of the most persistent and observant Paramedics in the field. She came to be known by the staffs in the ER's as one of the best pre-hospital diagnosticians who would latch onto minute details that many would dismiss as insignificant and make an accurate assessment of possible causes. I cannot tell you how many lives this woman saved advocating for her patients with the staff and could be quite annoying about it. But most knew, not to dismiss her findings.

When she arrived, her 40 year old was walking around but clearly in pain. He told the Medics what he tried to relieve the hiccups and the pain in his knee but the symptoms persisted and after 3 hours were getting worse. He just wanted advice and didn't think he needed to go to the ER.

His vitals were stable, except for an irregular pulse. An three lead EKG, showed some irregular beats whenever the patient hiccuped. This was before Paramedics were able to do a 12 lead EKG, but it set off alarm bells for the Medics. They gave him a chewable baby aspirin and a nitroglycerin tablet. The symptoms persisted.

He wanted to RMA, refuse medical assistance and transport, the Medics wouldn't let him. The patient argued that it was his right to refuse so they called medical control to have the patient talk to a doctor. After the call, the doctor said to let the patient RMA. The female Medic said no, she was going to convince this man that he needed to be in the ER. The doctor wished her luck. Finally after another round of her telling the patient the possible consequences of an undiagnosed irregular heart beat and the painful hiccups, the patient relented.

He wanted to walk to the ambulance, they wouldn't let him. They sat him in the stair chair and carried him to the ambulance placed him on the stretcher and brought him to me. The female medic gave the presentation that she suspected a myocardial infarction, Her partner looked a bit more skeptical but didn't contradict her, he had been her partner for too long and knew arguing with her when her mind was set was futile. Besides he told me later, she was way too often right.

The patient's first words to me were: "This is so embarrassing. I'm sorry. I don't need to be here."

The first thing that was done: a 12 lead EKG.

His diagnosis, Acute Inferior Wall MI, the proverbial "widow maker". He went to the OR that night, triple bypass and went home 5 days later.

Yes, that could have killed him that night if it hadn't been for the persistence of stubborn Paramedics who thought his complaints were too bizarre to ignore.

The moral of this story is if you don't feel well, it's getting worse, not getting better or going away, it's not normal.

To illustrate how similar heart attacks, strokes and dehydration are, here are the signs and symptoms and what to do if you, or someone else, is exhibiting any of these signs or symptoms. These are all life threatening emergencies.

Remember two things the patient may not be able to communicate that there is a problem and time is of utmost importance. So, don't hesitate to act promptly. It could save a life.

 Signs and symptoms of a Stroke

Signs of Stroke in Men and Women

    Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
    Sudden confusion, trouble speaking, or difficulty understanding speech.
    Sudden trouble seeing in one or both eyes.
    Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
    Sudden severe headache with no known cause.

Call 9-1-1 immediately if you or someone else has any of these symptoms.

Acting F.A.S.T. Is Key for Stroke

Acting F.A.S.T. can help stroke patients get the treatments they desperately need. The most effective stroke treatments are only available if the stroke is recognized and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for the most effective treatments if they don’t arrive at the hospital in time.

If you think someone may be having a stroke, act F.A.S.T.1 and do the following simple test:

F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—Time: If you observe any of these signs, call 9-1-1 immediately.

Note the time when any symptoms first appear. Some treatments for stroke only work if given in the first 3 hours after symptoms appear. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

Signs and Symptoms of a Heart Attack
Not all heart attacks begin with a sudden, crushing pain as you often see on TV or in the movies. The warning signs and symptoms of a heart attack aren't the same for everyone. Many heart attacks start slowly as mild pain or discomfort. Some people don't have symptoms at all, which is called a silent heart attack.

Sometimes the signs and symptoms of a heart attack happen suddenly, but they can also develop slowly, over hours, days, and even weeks before a heart attack occurs.

The most common symptom of a heart attack is chest pain or discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. It can be mild or severe. Sometimes the pain feels like indigestion or heartburn.

The symptoms of angina can be similar to the symptoms of a heart attack. Angina is pain in the chest that occurs in people with coronary artery disease, usually when they're active. Angina pain typically lasts for only a few minutes and goes away with rest. Angina that doesn't go away or that changes from its usual pattern may indicate the beginning of a heart attack and should be checked by a doctor right away.

Other common signs and symptoms that a person can have during a heart attack include:

    Upper body discomfort in one or both arms, the back, neck, jaw, or stomach,
    Shortness of breath with or before chest discomfort, and
    Nausea, vomiting, lightheadedness or fainting, and breaking out in a cold sweat.

Not everyone having a heart attack experiences the typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, the more signs and symptoms you have, the more likely it is that you're having a heart attack.

Acting quickly when you notice heart attack signs and symptoms can prevent damage to your heart and may save your life. Know the warning signs of a heart attack so you can act fast to get treatment.

Call 9–1–1 for help within 5 minutes if you think you may be having a heart attack or if your chest pain doesn't go away as it usually does when you take prescribed medicine.

Don't drive yourself or anyone else to the hospital. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

The sooner you get emergency help, the less damage there will be to your heart.

Signs and Symptoms of Dehydration
Symptoms of Dehydration in Adults

The signs and symptoms of dehydration range from minor to severe and include:

    Increased thirst
    Dry mouth and swollen tongue
    Palpitations (feeling that the heart is jumping or pounding)
    Sluggishness fainting
    Inability to sweat
    Decreased urine output

Urine color may indicate dehydration. If urine is concentrated and deeply yellow or amber, you may be dehydrated.

The symptoms that BoiseBlue had were alarm bells that something was really wrong and getting worse. There were a number of causes for her symptoms but only one way to find out that cause: Go To The ER.

Stay healthy

An very important addendum from Crone Wit reminding that heart attack symptoms for women can be quite different:

Heart attack symptoms for Women http://www.heart.org/...]

    Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.

    Pain or discomfort in one or both arms, the back, neck, jaw or stomach.

    Shortness of breath with or without chest discomfort.

    Other signs such as breaking out in a cold sweat, nausea or lightheadedness.

    As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

    If you have any of these signs, don’t wait more than five minutes before calling for help. Call 9-1-1 and get to a hospital right away.