What could this be?
“Yes, I have chest pain, but it is positional. . . . I am NOT having a heart attack.”
“You are over forty, past history of diabetes, hypertension and hyperlipidaemia?”
The first part is not encouraging. We have heard that kind of rationalization before. This may be what they were thinking,
But –
If you read the rest of what Lawdog wrote, you should realize that he was not rationalizing. The parts of the paragraph that I left out included a lot of important information about the current symptoms being consistent with previous episodes of pericarditis.
My favorite question is, Have you ever had similar symptoms before? I will try to word this whatever way seems appropriate for the patient.
The patient may not be right, but we should not start out trying to prove the patient wrong.
History of pleurisy diagnosis?
Is this different from previous episodes of what was diagnosed as pleurisy?
Textbook case of pericarditis?
Do risk factors change any of that?
No.
Risk factors are for determining the lifetime risk of a medical condition.
Risk factors have nothing to do with evaluating the current medical condition.
If you disagree, please provide some evidence that the use of risk factors improves identification of medical conditions.
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Of course, this was followed by the NP bounding into the room, EKG clenched in one paw like the Six Lost Commandments, and announcing, “You! Are having a heart attack!”
Does the ability to misinterpret 12 lead ECGs make it any more likely that the patient is having a heart attack?
No.
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Click on images to make them larger. This is similar to the ECG the NP (Nurse Practitioner) would have been looking at. From EMS 12 Lead – see the discussion.
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“You are! Right now! Here, swallow this aspirin! Good, slip this under your tongue! Now, see this EKG? This part! You don’t understand it, but trust me! This is your heart dying! Denial does not change fact!”
Will treating the patient for the wrong illness improve the patient’s medical condition?
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Does an absence of risk factors make it less likely that the patient with crushing substernal chest pain, radiating to the neck and jaw, onset at rest, . . . , is having a heart attack?
Don’t worry. He doesn’t have any risk factors. It can’t be a heart attack.
Should any of us think anything remotely like this? Ever?
Absolutely not!
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If we turn that around and look at the patient with a textbook case of pericarditis, do the cardiac risk factors make it more likely that this is a heart attack?
Go read Pericarditis, and you by LawDog. The patient’s perspective is too often ignored.
The patient is too often ignored.
Part of our assessment is listening to the patient.
The patient may not be right, but we should not start out trying to prove the patient wrong.
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The way LawDog writes is wonderful, so go read the whole thing. It gets much more entertaining – beverage alert entertaining. Then read Part, the Second.
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Also read –
Pop Quiz for the Paramedics and especially the comments.
39 year old male CC: “Sick” – the comments are also important here.
39 year old male CC: “Sick” – Discussion (Pericarditis)
The discussion explains the image below.
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Is Tom calling this a Scallywag ECG?
.
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