Recently, I had an employee who showed up to the treatment room with a colleague. They didn’t look well. They were sweating, looked pale and were clutching at their chest. So I got permission to begin assessing them and started with a primary survey.
“A primary survey should take no longer than one minute to complete. There are five parts to it, which we use the term ABCDE. It begins with assessing the patient's airway to make sure everything is okay there. Then, we move on to the breathing and respiratory rate before looking at the oxygen saturation levels using a pulse oximeter. This indicates what percentage of oxygen is in the body. We then need to check circulation by checking the pulse and then carrying out a capillary refill test on all four limbs by pressing down on the fingernail bed for five seconds to ensure it refills with blood within two seconds – in doing this; we are ensuring blood is circulating correctly to the limbs.
The next part of the primary survey is checking the patient’s skin colour, condition and temperature. Then we carry out a check on the patient's disability levels to see if the patient knows where they are, what day of the week it is and so on. Lastly, we expose/examine the patient's area of complaint. At this stage, I had carried out a primary survey using ABCDE - airway, breathing, circulation, disability & expose/examine - and due to the symptoms obtained, I concluded that the employee's clinical status was serious/life-threatening.
I suspected that the employee may have been suffering from a Myocardial Infarction (Heart Attack) due to the symptoms obtained; the employee also mentioned having some discomfort down their left arm, which was an additional indicator for me.
“At this point, I decided to administer my first dose of medication, which was Aspirin. Understandably, pre-checks needed to be carried out first. I had to check for indications and contraindications before administering the medication – ensure the employee was over the age of sixteen, ensure they were not haemophiliac or had any other blood disorders, and rule out any stomach ulcers or allergies to Aspirin. Aspirin administration is fairly common in situations like this one as it prevents clots from forming in the blood”.
During my secondary survey, I decided to monitor their baseline vital signs, and as part of this, I connected them to a three-lead ECG, which allows us to take a look at the output of the heart. Due to the rhythm obtained, I decided to call the ambulance service for support.
The employee was in quite a bit of pain, so I decided to administer Glyceryl Trinitrate (GTN), which is a spray that widens the arteries and reduces pain while assisting with better blood flow. Before administering GTN, I was required to check the blood pressure, the indications and contraindications, including some additional personal information about the employee. Thankfully, the employee was able to take it. This intervention seemed to have a positive effect, as the employee reported a lower pain score shortly after.
Throughout the incident, I continued to monitor the employee's vital signs to look for any improvement. I also decided to initiate oxygen therapy while I waited for the ambulance service to arrive. The aim of my treatment was to help the employee by keeping them calm and giving them the sense that they weere being fully cared for. Around twelve minutes into treatment, the employee's condition seemed to have improved slightly.
At this stage, I assumed that the employee was suffering from a suspected heart attack; I mentioned this to the responding paramedics during my handover. The responding crew were able to carry out a 12-lead ECG to obtain a better picture of the heart. Unlike our EMT, the ambulance services can Bluetooth the obtained ECG from the monitor and send it to the cardiologists throughout the specialist hospitals. On completion of my handover, the responding crew made the call to transport the employee to the hospital.
In the end, although the employee was exhibiting every sign of a heart attack, it turned out that they were suffering from an undiagnosed condition known as ‘pericarditis’. It was great to catch it early on, and from what I understand, the employee is now doing quite well.