Last week I talked about what happens on the EMT side of things when we get called out to a heart attack, so this week I’m going to approach it from the other direction. I think most people are aware of the usual signs: pain in the jaw radiating down the left arm (or sometimes both arms), chest pain (ranging from mild to excruciating), back pain, shortness of breath, and nausea—these are all typical symptoms for men, who may experience some or all of them.
But did you know women often don’t show any of the classic symptoms? Sometimes they do show them, but often when women talk to us, they say they’ve felt sick, or maybe they’ve just felt ‘off’ for a while, when what they’ve been feeling is heart attack symptoms. Because of this, when we respond to a woman with odd complaints, a lot of times we’ll put on the heart monitor just to see if there’s anything going on there.
People who have previously had heart problems often have a prescription for nitroglycerin, which is a TINY pill that the patient puts below their tongue and allows to dissolve there. They might also have been directed to take four of the low-dose aspirin. These used to be referred to as baby aspirin. These are the 82 mg aspirin. And yes, people, baby aspirin is still aspirin, if you’re allergic to one, you’re allergic to both. (Yes, this is a common misconception.) The best way to administer aspirin is to chew it up, then either stick it under the tongue, or hold it in your mouth against the cheek. This is because it will absorb into the blood stream faster in these places than from the stomach.
Now, if your viewpoint character is a bystander, rather than the patient, they’re going to call 911. Every dispatch department has slightly different dialogues they run, but our local department answers the call: “911, what’s the address of the emergency?”
Hopefully your character knows where he or she is because sometimes the addresses that come up on the computer the dispatcher sees aren’t accurate, and if your character is calling from a cell phone, the cell tower triangulation system isn’t always right, even in big cities, though it’s getting better all the time. If you aren’t sure if the 911 system has your address right, you can call your local dispatch center and arrange to check (they’ll have you call 911, but calling the dispatch line first is a good idea in case they’re busy with a REAL emergency right then.).
Once the dispatcher knows where the emergency is, he or she will ask what the emergency is, this is so they know what kind of assistance they need to send out and so the ambulance (since one is going to be needed in this scenario) knows what to prepare for before they reach the emergency. Where you live may determine what resources are dispatched as much as what the actual emergency is. In a city with a department that runs both ambulance and fire trucks the dispatcher will sometimes send an ambulance and a fire truck for things like heart problems. It possible they could dispatch an officer as well, but usually only if there’s reason to believe one might be needed.
In my small town we don’t usually have a fire truck dispatched to medical emergencies unless we need extra muscles (our EMTs are mostly women), but I’d say 95% of all calls that the ambulance goes out on, we get at least one sheriff’s deputy on scene, sometimes two. Usually, they arrive before we do (which we love!). I know of other small towns that routinely call out a fire truck to assist on every medical call even though they are separate departments, so you can run it either way.
Okay, your character has called 911, given out the address, and explained the symptoms. If the patient is unconscious, the Emergency Medical Dispatcher (EMD) will then give directions to the bystander for doing CPR if they’re willing and calm enough to do compressions. Again, in a small town the deputy or police officer may arrive first. They don’t do CPR, but can check for heart rate and breaths and relay that information to the EMTs so when the ambulance arrives, they have better information than the bystander might have given dispatch. Also, our state troopers all carry oxygen and masks in their cars, though I don’t think the deputies do, so sometimes the patient already has oxygen when we arrive.
Then the EMTs and maybe firefighters arrive. Look at last week’s post for specifics on what they will do.
Okay, now for CPR. The American Heart Association puts out new CPR guidelines every few years as they continue to do more research. The latest protocol for the average person who sees someone go into cardiac arrest is just to do compressions. No breaths.
They found that first: there’s ten minutes worth of oxygen in the blood when someone experiences the heart attack, so breathing isn’t nearly as important as it was once believed to be. Second, when you do compressions right, it actually forces some air in and out of the lungs, so you are oxygenating the blood a little. Third: whenever you stop doing compressions to give breaths, the blood pressure in the brain goes down quickly, and keeping oxygen going to the brain is very important for the patient’s recovery.
And fourth: a lot of people weren’t doing CPR because they didn’t want to do mouth-to-mouth on people they didn’t know--and I don’t blame them. Sometimes the nicest, cleanest cut people out there can end up having really bad illnesses you don’t want to catch. As I mentioned last week, a large percentage of CPR patients end up vomiting, and no one wants to have that happens while they’re doing rescue breathing. Unless you’re in a very out-of-the-way area, chances are the ambulance will arrive within ten minutes, so compressions are the key. On the other hand if you find someone who is already down and you don't know how long they've been out, then rescue breaths are a good idea (if you know the person).
A few tips (and really, go take a CPR class, lots of times they’re offered in your communities, and if you contact fire/ambulance departments, you can often get them to come teach a class for free to your church group, club, or other organization.). If you just need a refresher, here's a Youtube video with great directions. When we teach or practice compressions, we do one for every beat in the Bee Gees song “Stayin’ Alive.” If you haven’t heard it recently, you can find it here, and yes, that’s a pretty fast.
Also, an interesting thing you should note: doing chest compressions properly almost always results in broken ribs on adults. For me as the person doing CPR, that means I’m going to feel popping under my hands during the first few compressions. For your character (assuming they live), that means weeks of chest pain as the ribs heal.
Labels: Emergency Medicine for Writers, Heart Attacks, Medical Monday