Not Just Acid Reflux: The Need to Think Worst First

Discussion Heart disease is the leading cause of death in the United States.1 This year, 720,000 Americans will have a new coronary event—defined as first hospitalized myocardial infarction (MI) or coronary heart disease death—and around 335,000 will have a recurrent event. Approximately 35% of people who experience a coronary event in a given year and around 14% of patients who have an acute coronary syndrome will die from it.1 Roughly 60% of patients with an acute coronary syndrome are transported to the emergency department via ambulance.2–4. Up to one-third of patients experiencing an MI may not complain of chest pain, but rather present with atypical symptoms such as nausea, weakness and shortness of breath.5 Women, the elderly, and patients with diabetes are at higher risk of presenting with atypical symptoms.2,3,6 Patients who present with atypical symptoms are less likely to have prehospital ECGs performed and are more likely to have longer elapsed times from first prehospital medical contact to percutaneous intervention.2,7 In 2015, the Los Angeles Fire Department had over 391,000 unique EMS incidents, including 31,499 dispatches categorized as chest pain; 14,101 incidents with a prehospital provider impression of chest pain; and 2,607 ST-elevation myocardial infarctions (STEMIs). On review of records from 2010–2015, 90% of cath-lab confirmed STEMIs among males were dispatched as chest pain, whereas 80% of such cases among females were dispatched as chest pai...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news