We get dispatched to a familiar address for “difficulty breathing”. As we pull up on scene, the fire captain walks up to the ambulance and says “he’s having another asthma attack, my guys are walking him out right now”. I wasn’t particularly thrilled with his decision to walk the patient, but at this point the patient was already walking up to the ambulance.
The patient is 67 years old, deaf and has a history of chronic asthma. He typically calls about once a week when he runs out of his Albuterol and gets short of breath. The call started out pretty much just like every other time I have transported him. I’m initially thinking “O2, monitor, IV and an Albuterol treatment and we should be good to go”.
I listen to his lung sounds and hear wheezes in all fields. This is pretty much normal for him as mild wheezes are pretty much his baseline. He happens to read lips quite well, but doesn’t really speak. I look him in the eye and ask, “are having another asthma attack?”. To my surprise he shakes his head “no”. A bit puzzled, I ask “are you short of breath?”. He motions “yes”. So now I start with a different route of questioning.
Sean: Does this feel like your asthma is acting up?
Patient: No
Sean: Are you having pain?
Patient: Yes (and points to his chest)
Sean: Have you ever felt this way before?
Patient: No
So now my treatment plan completely changed from a respiratory emergency to cardiac. I wasn’t able to determine length of time or a pain scale due to the language barrier, but I did know enough to start treating him.
I placed him on oxygen, started an IV and administered 325mg of ASA. His bp was 98/palp so I did not administer nitro. His monitor showed sinus tach at 110 and an Sp02 of 99%. We arrive at the ER, place him in a bed and the staff does a 12-lead ecg. Sure enough, the patient was having an MI and was taken to the cath lab.
This call really got me thinking about how easy it would have been to just run with the asthma idea and completely mistreat the patient. Administering Albuterol would have increased the workload on the heart and potentially made the MI worse. Who’s to say that the hospital would catch the error?
If anyone else has similar stories, I would love to hear it.
