When A Fall Isn't Just A Fall

We walked into the house and found the patient laying on the ground on his right side. The daughter said that her father didn't speak English but she was willing to translate. Thankfully he was a Spanish speaker so I didn't need her assistance. There always seems to be something lost in translation when using an interpreter.

It was obvious from the beginning of my assessment that the patient had a problem with his right hip. He was holding it and moaning in agony. I asked how he had fallen and he said he wasn't sure. He explained that he had more or less crumpled to the ground landing on his hip. Then he tried to curl up in the fetal position to ease the pain.

My engineer grabbed me a set of vitals, which were all WNL. I set up my IV equipment and got a line in with the intent of giving some morphine ease his pain. While I was doing this there was still that nagging feeling that I was missing something major. I asked the patient again how he had fallen. Same answer. I asked if he felt weak or dizzy before falling. Yes, and he still felt dizzy and lightheaded.

Bingo.

I had my engineer toss on the electrodes and I took a look at the monitor. In lead II there was ST segment depression (I guess I should add a 12 lead interpretation to my cardiac series). I set up and shot a 12 lead and saw what I was expecting. The patient had ST elevation in leads V1 through V3 with reciprocal ST segment depression in leads II, III and aVF.

In laymen terms, he was having a heart attack.

Thankfully by this point AMR was on scene. I gave the patient some aspirin and then some morphine. The patient denied any chest pain, pressure, or discomfort so we didn't administer nitroglycerin. After rechecking his vitals we gave him a little more morphine and then loaded him up as best we could.

Since the patients condition was serious and because I was the only one with the ability to communicate with the patient I got to ride along to the hospital. The trip was uneventful.

Once in the ER the patient met the cardiologist and from there was sent to the cath lab.

Insult To Injury

A nearly 80 year old man lay awake in bed trying to take a nap. His wife, laying next to him, was worried. She didn't think he looked well. He insisted he was alright and refused any help.

About 30 minutes later the old man jump up and ran for the bathroom. Half way there he started to throw up on the hard wood floors. As he tried to round the corner to make it to the toilet the combination of emesis, hardwood floors, and inertia proved too much for him. When his wife found him passed out she called 911.

We arrived to find the gentleman hugging the porcelain god in nothing but his tighty whities. He had managed to crawl over to the toilet after waking up. We collectively decided that dignity is worth a small delay in patient care so we waited while he cleaned himself up and slipped into a bathrobe.

Out in the living room we began to get a clear picture of things. The patient had had an MI about a month ago and had several stents placed. He had only been released from the hospital a few days before. After some prodding he admitted that he had been feeling ill for a couple of hours (that really angered his wife).

The patient wasn't complaining of chest pain but did say that it felt the same as it had when he had his last heart attack. That's an attention getter. While my engineer grabbed a set of vitals I set up for a 12 lead. As soon as we were finished shooting the EKG we put on oxygen and gave him some aspirin.

When AMR showed up we gave them a report along with the 12 lead showing that he was having another MI. We moved him over to the gurney, which the stubborn old guy really didn't like, and AMR sped off to the cath lab.

Poor guy. I hope we caught this one early enough for a good outcome. I guess he's looking at several more days of hospital food. Maybe he'll be visiting the porcelain god again.