Mission Impossible: treating chest pain in a third world setting
When he mentioned it had been there since waking up, varied with twisting his torso, and wasn't worse with lugging the suitcases around, i felt more assured. But what scared me was the increase in pain from walking up the tarmac, and his lightheadedness, as if he'd pass out. I asked the stewardess to call for an ambulance, laid him down on the floor, raised his feet and prayed for the best. They were a bit reluctant until i emphasized i was a doc and showed them my license -- as if they knew what our licences look like!
Fortunately, the ambulance came quickly, but when we loaded him into the rig, i was suprised. No quick check on rhythm -- no defibrillator. No IV to try and improve his hypotension from 80/40. No nitro, but thank goodness we had some on hand. Just some oxygen (or at least some gas coming out of a bubbling tubing), and a bumpy 30 minute ride to the hospital.
Once there, everyone sprang to action, starting IVs, giving the rest of the aspirin he needed, getting an EKG and comparing it to the old one faxed to the ER, and fortunately ruling out for a heart attack with negative test results.
If I were to have to do it over, I think I would have rolled back into the plane, where they had an AED which i could have checked his rhythm with, and had some more basic equipment to stabilize him for transport.
[roll Mission Impossible music]
This mission if you choose to accept it, will include diagnosing a patient with chest pain in a foreign country.
Dream devices for this mission include:
Mobile phone review of his electronic medical record (locked up in Singapore) of past workup of chest pain
PDA aquired EKG (they have these available for palm)
Fax reception via the windows CE HP smartphone we were carrying (to recieve the old ekg)
IV catheters, tubing, and Normal Saline solution
Aspirin, Sublingual nitroglycerin and nitropaste
Medivac by helicopter to the nearest cardiac catheterization lab (if necessary)
Is this too much to ask for? Yeah, probably, but it was what I was wanting 1 week ago...
Don't expect as many firsthand accounts of the need for medical devices in the coming months, but tune in regularly for just as exciting reviews of technologies that are emerging, and available now.