For the second time in two weeks I did a job where we did some actual good. To be completely honest it put my crewmate and I on a bit of a buzz for the rest of the day.
The job stated out as a bog standard chest pain; 41 year old male, pain in the chest radiating down his left arm. He is originally from the Indian sub-continent and people from this part of the world tend to have a lot of heart problems.
It didn't seem like a big job to be honest, he didn't look like he was having a heart attack – he wasn't sweaty, the pain got worse when he breathed in (often a sign of non-cardiac chest pain), he didn't have the 'feeling of impending doom' that is described daily in ambulance training schools across the world.
But he just didn't look right. I have no idea what it was about him, but there was something about him that set alarm bells ringing.
So we popped him onto our carry chair and wheeled him out to the ambulance in order to do a few checks before taking him to hospital.
His blood pressure was high, but everything else seemed fine. As we were preparing to do an ECG (a tracing of what is going on in the heart) my crewmate and I agreed that no matter what it showed we would be 'blueing' him into the local hospital, just based on the feeling we had about the patient.
His ECG printed out and we realised that we wouldn't be going to the nearest hospital around 400 yards away.
There is something that the LAS do exceptionally well, and that is to diagnose heart attacks (properly called Myocardial Infarctions, or MI's). We have good experience of spotting ST segment elevation MI's and dealing with them accordingly. Not so long ago the treatment for an MI was to have a 'clotbusting' drug which worked most of the time and has the possibility of some serious side effects (like bleeding onto the brain and death). Recently, in London at least, some specialist hospitals have been offering 'primary angioplasty' which is a surgical proceedure where a wire is threaded from your groin into your heart and the blockage is cleared manually. It's done under a local anaesthetic and is the gold standard treatment.
So now the LAS will diagnose a heart attack and instead of taking you to the nearest hospital for sub-standard treatment, will take you to the specialist unit for the best treatment possible.
This patient was having a massive MI. Absolutely life-threatening.
He had been waiting for a same day appointment to see his GP about the pain, but as the pain got worse he'd wisely called for an ambulance.
We gave him aspirin, morphine and GTN – good, immediate treatment for his MI, and blued him to the specialist unit.
As we arrived we showed the receiving doctor the ECG heart trace. He told us that, “That's all I need to see, bring him straight through”. We moved him onto the hospital's trolley and left him in the care of the doctors while they assessed him for surgery.
Then his heart stopped pumping blood.
He was dead.
Rapid, effective treatment by the doctors restarted his heart within a minute and he was soon asking them if he had just fainted. During this I was explaining to the wife what was happening. English wasn't her first language so she was confused by what was going on.
He was rushed into the surgery room and the doctors asked if we would like to see the proceedure – as we were doing our paperwork we agreed.
An x-ray image of his heart came on the screen as they pumped a contrast agent into his blood to show where the blockage was.
There are two main arteries feeding blood to the heart, one branch of these was completely blocked. The doctor described it as 'The widowmaker'; a severe blockage in exactly the wrong place. This was almost certainly why his heart had stopped beating effectively while they were preparing him for surgery.
We watched as they did a bit of delicate plumbing work to remove the blockage and restored the flow of blood to his heart.
While he will almost certainly survive this episode, I wonder what damage has been done to his heart; the MI causes part of the heart to become starved of oxygen and this can reduce it's function.
If he'd waited the hour to go and see the GP, he would be dead.
If he hadn't called for an ambulance, he'd be dead.
If we weren't routinely trained to recognise MI's and take them to the right place, he'd be dead.
If the primary angioplasty wasn't available, he'd probably be dead.
Everything went right on this call, we felt that we had saved his life (a rarity in this job), and it let us feel that we had earned our pay today.
Another 'good' job.
And our next two jobs were picking up unkempt homeless drunks from the street. It doesn't do to get an ego in this job…
For the medically minded, he had a VF/VT arrest, corrected after two shocks and a complete blockage of the LAD about 3mm from the base.