I was working at Emergency Department of KIST Medical College Teaching Hospital on 24th Jan night. A middle aged man presented with complain of mild dizziness at 10:30 PM. As the Emergency Room was almost full with so many other cases I didn’t give much attention to that patient. Vitals were stable too. His GRBS was 150 at time of arrival. I was annoyed working all evening and was like “Why is this man here at this point of night? He doesn’t seem to have any problem.” I then somehow thought of doing an ECG as a part of routine formality.
Damn! There was ST-Elevation Myocardial Infarction!
As an attending doctor in the emergency, I gave him Aspirin, Clopidogrel and enoxaparin immediately. I didn’t administer morphine as he was symptomatically normal. We then referred him to the Cardiac Speciality Center for further management.
That night at Emergency was like one of biggest life lessons to me. All the symptoms need special attention unless proven otherwise particularly when you are working in Emergency Care Settings.
By the time you have reached this line reading this post, on average at least two person in the world will have started to clutch her chest. Approximately 1.5 million cases of myocardial infarction (MI) occur annually in the United States; the yearly incidence rate is approximately 600 cases per 100,000 people[Rogers WJ et al. 2008]. The blood flow to their heart will become blocked and cardiac muscle cells will start to die off and get replaced with scar tissue. This person has just suffered a heart attack and most likely will go on to develop heart failure, a weakening of the heart’s ability to pump blood and oxygen. In five years’ time, there’s a 50/50 chance they’ll be dead.
I was lucky that I could identify his condition and save his life. Every day we see hundreds of patients , sometimes we are irritated by a lot of work burden. Being in that rush, we sometimes tend to avoid patients’ symptoms and problem thinking it’s nothing serious. But every case is special in a different way and everyone needs a special attention. Every patient is a new chapter for a doctor even in minimal resource settings. We just need to have eyes to see and mind to learn at the right time.
My one line summary is that, whenever you see a case of 40 years and above while working in emergency settings, please send some baseline investigations and do an ECG immediately.