So, where were we?
Click here if you need to read what happened up to this point.
So I’m standing in the back of the ambulance, just about to move the patient into the A&E department. I have seen the ECG which now shows definite inferior involvement and ST elevation.
I ask my partner to stay with the patient whilst I quickly run into the department where I ask one of the nurses if I can speak to a senior doc. I am shown to the consultant and I quickly say:
“I have a patient outside who has been having cardiac chest pain along with ECG changes suggestive of unstable angina. I now believe that she is starting to infarct. Do you have any objections to me not bringing her in and just heading off to the PPCI centre instead?”
” Does she need resuscitating?, is she stable?”
” At the present time she is okay, her pain is a 4 on a 0-10 scale and all her other obs are stable and within normal limits ”
” Sounds good, I’m happy for you to go”
As I was walking away I heard her say
“Who was that? Can we have more like him please!!”
Now I know this was not a compliment on my diagnostic abilities and choice of treatment, but was more likely the appreciation for not bringing a critical patient into an already heaving A&E department!
Back on the ambulance and I try to transmit the ECG to the PPCI centre, however the transmission keeps failing, so I phone them up and speak to the senior nurse on duty. We discuss the case and she accepts the patient for PPCI based on my interpretation of the ECG:
” If you are sure he is infarcting then you can bring him here……if you are sure”
Yes, I’m sure and we are now on our way, travelling with lights and sirens. I give some Morphine, titrated to effect, to ease some of his pain on the way and manage to keep the pain score down to a 4. We arrive at the PPCI centre approximately 20mins later and move him straight into the cath lab where the team attack him from all sides!! We say our goodbyes, handover and move back to the ambulance where we reflect on the job that we have just done.
I took one final ECG on arrival at the PPCI centre which looked like this:
I phoned the coronary care department a few hours later to enquire how he got on and was told that they had stented his circumflex artery, and he was looking really well. The team complimented us on our decision and suggested that the time from infarct to stent was less than an hour and is likely to have a really positive effect on his heart function following this MI.
Reading through the comments you all left after the original post, most of you would have done the same thing, which is reassuring for me. I was very happy with what I decided to do, but there is always that worry……what if he arrested on the way?
Would both hospitals have been so supportive of my decision then? I`ll leave that one up in the air I think.