yeah, so, you're having a heart attack

[paramatt_]

I was recently mentoring/precepting a paramedic student, called to a 57 year-old with chest pain. Patient normally well and healthy, on beta-blockers and a PPI. Anyways, presented with the following (of what I can remember):

Central chest tightness, onset at rest, 8/10 at worse, clammy, nauseous, sinus rhythm, BP 165/90, anterior ST-elevation. Both the family and patient are quite anxious.

The student, who was treating and doing the questioning/communicating with the patient, looks at me after the ECG is done to confirm what he's seeing. After a quick discussion of what the findings are and what our plan is, he says to the patient "It appears you're having a heart attack"

+1 for being truthful, -100 for not thinking about another way delivering this to an already anxious patient and family.

We had a good chat about the whole thing after the call, but wondering how everyone out there goes about this in an acute setting. Obviously there is no 100% correct answer as all situations are going to be different, but just curious of what sorts of methods work well from your own personal experiences.

[EMTDenny]

LOAD AND GO.

I have no personal experience with chest pains, yet.

But sounds like a LOAD AND GO will have to do. I mean, is their a certain way to tell a PT they are having a AMI?

Edited March 15, 2012 by EMTB.Denny389

[Kiwiology]

Anterior ST elevation on 12 lead ECG is classified here as status one or immediately life threatening problem as the left ventricle is often involved or at risk; this is not often well understood.

Your student did nothing wrong in my opinion. It is entirely appropriate to tell the patient "we highly suspect you are having a heart attack".

[WolfmanHarris]

I don't have a huge problem with that actually. I think direct, clear language is effective when done right and with confidence, especially when you need to convey the immediate seriousness of a situation. My usual script for a STEMI is something to the effect of:

"Sir/Ma'am, at this time it appears you're having a heart attack. We're going to be taking you directly to the cardiac unit at *redacted* Hospital. We'll be treating you with medications to relieve the workload on your heart and reduce your pain."

Plain, direct language doesn't preclude maintaining a compassionate, caring tone and body language. Maybe that's what your student's problem was?

[paramatt_]

I mean, is their a certain way to tell a PT they are having a AMI?

Denny, that's basically what I'm getting at....what works well from personal experience to relay this info to a patient without making the situation more stressful for everyone involved. The patient is going to get an aspirin, 02, a cannula, nitrates, a quick transport etc, but you still have to explain why all this is happening in a way the patient understands.

And Kiwi, i'm all about being open and explaining to patient's what is happening, but being completely blunt with little empathy or thought behind it might not go down well, especially with the acopic or anxious types.

[Kiwiology]

And Kiwi, i'm all about being open and explaining to patient's what is happening, but being completely blunt with little empathy or thought behind it might not go down well, especially with the acopic or anxious types.

I didn't say not to say it in an empathetic manner

And "acopia" is not a real medical word for lack of coping; neither is "dyscopia"

[Just Plain Ruff]

Nothing wrong with being direct and to the point but do it in a nice way.

Just tell the patient that what you are seeing makes you believe they are having a heart attack and they need to go to the hospital.

simple short and direct. You can pour a 5 pound bag of sugar on it, then put 2 gallons of butter brickel ice cream on it and then top it off with a cherry but then you've got to treat their blood sugar as well. So why not just tell em they are having a heart attack.

[DFIB]

Patients want to know what is wrong with them, in fact patients need to know what is wrong with them.

I find that patients are appreciative of honesty in describing their conditions and our interventions.

EDIT: Among Hispanics I have seen people hide illness from their patient family members. Dad is wilting from cancer but the family lets him believe he is going to get better or they will hide one family members condition from their spouse. Doctors play along in this game as well. It is crazy.

Not my intent to derail the thread.

Edited March 15, 2012 by DFIB

[Just Plain Ruff]

I just re-read the original post and I don't think the student did anything wrong with the way that he told the patient. Absolutely nothing if the student said it exactly like he said it. But the nuances of communication may have been totally different and sounded different.

to me "it appears that you are having a heart attack" is exactly what I want to hear when I'm having a heart attack rather than "you are having the big one, if you have a will you better polish it" or something like that.

short simple and to the point. That's what I want to hear. You won't get a -100 for putting it like the student put it.

Edited March 15, 2012 by Captain Kickass

[island emt]

DO NOT ever lie to a pt or sugar coat the issue.

What would you do: tell them he's just having a little indigestion and we want him to be seen at the local quack clinic??

If the patient is havinf a heart attack that could be potentially fatal , then he and his family need to be informed of that fact.

Yes you explain the how & why you have diagnosed the problem and tell them you are going to a proper medical facility to handle the issue. BUT don't ever blow smoke up a pt's ass and lie to them. PERIOD!