| Paramedic’s Corner: To survive chest discomfort, call 911 sooner, not later |
By: Ambulance Director Gary Carmack
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Posted: Wednesday, May 13, 2009 7:43 am
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Gary Carmack
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Tragically, Americans with trouble breathing or vague feelings in their chest frequently wait too long before calling 911 and getting the paramedics. This is referred to as denial.
No one wants to have a heart attack. It is our human nature to want to believe that trouble breathing or chest discomfort is from indigestion, sore muscles, or almost anything other than our heart. It is just too scary to accept. Frequently people will wait anywhere from two hours to days before getting help. Many of these people either die from sudden cardiac arrest, die later from too much heart muscle damage, or have permanent muscle damage resulting in a very disheartening lifestyle.
Heart attack, sudden death, or acute coronary syndromes can occur at rest or with moderate activity. Heavy physical exertion or mental stress may play a role in many of these tragedies. On the other hand, it is possible for someone to be resting in their favorite easy chair, be relaxed while reading a book, and have a heart attack or sudden death.
The most important factor is teaching our family and friends to enter the EMS system by calling 911 at the first onset of possible cardiac symptoms. These are not only symptoms such as chest pain, but also lesser-known symptoms such as unexplained weakness, lightheadedness, fatigue, arm, jaw, neck or tooth pain; trouble breathing, or unexplained nausea/vomiting and sweating for no reason. I think we put too much emphasis on “chest pain,” The reason I say that is most cardiac patients actually have trouble describing the feeling they have when having a heart attack. They have trouble finding the words to describe it clearly. They often describe “pressure in the chest.” This should be a warning that the problem may be cardiac. People will sometimes clench their fist and put it over the heart. This is called Levine’s Sign and may indicate a heart attack. This is named after Dr. Sam Levine who first noticed many heart attack patients would use this “body language” to help describe the symptoms to the doctor.
The importance of getting the paramedics en route cannot be stressed enough. Out of the 1.5 million or so AMI patients this year, approximately a half-million will die, and about half of these deaths will occur in the prehospital setting within the first two to four hours of the event. Many of these deaths would have been preventable if someone had called 911 to get the paramedics there quickly. As minutes go by without CPR and defibrillation, the patient’s chances of survival rapidly decrease.
The paramedics will initiate early treatment consisting of oxygen, nitroglycerin, morphine, and aspirin. Additionally, IV access will be used in case emergency life-saving medications are needed, and they will perform a 12-lead EKG and send it to the hospital.
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