Want to know what my biggest fear as a blogger is? Itís that one day you may find out that Iím an idiot. Youíll find out that there are things that I donít know, and those things that I donít know will be something that ďany idiot should knowĒ and if I donít know them youíll think that Iím not as smart as ďany idiotĒ.
Take this issue for an example. Say you have a 48yo M Pt with substernal chest pain. He indicates with his hand that itís radiating towards the lower left part of his chest from the manubrium. He stresses that he doesnít perceive it as ďpainĒ per se, but that he feels it more as a ďpressureĒ and he rates it at a 4 out of 10. He denies that it exacerbates to movement or palpation, and it doesnít change with respiration. His skin is slightly flushed and moist and he complains of some shortness of breath. He states that heís been experiencing it for an hour or so, and that itís getting worse despite antacid tablets and an aspirin he took. The patient has no medical history and takes no meds. He does have a family history of heart disease but has never experienced any problems.
What would we do here? Easy: a 12-lead, IV, o2, and EKG Monitoring is in order. You do that and getÖ
A normal 12-lead EKG. Nothing is wrong with it. Not a darn thing.
Doesnít that suck? I mean, no, not for the patient of courseÖ but for you. Now what are you going to do? Are you sure that this patientís chest pain isnít caused by cardiac ischemia? Youíve seen the 12-leadÖ but you also see the patientís presentation. They seem to contradict each other, donít they? If this patient had three boxes of ST segment elevation in three leads, youíd know right what to do and the treatment would be pretty straight-forward, right? Now itís not so clear.
Iíve vacillated in my career between giving nitroglycerine to these types of patients to make sure that there isnít something Iím missing with them. My usual decision is to prophylacticly give one NTG tablet (0.4mg SL) after the IV is in place under the doctrine of treating the patient and not the monitor; but I donít call the cavalry, activate cath lab, or give them the bigger drugs we have to give them (Our STEMI protocol includes: o2, Asprin, Nitroglycerine tablets and paste, Morphine, Metoprolol, and Heparin while bypassing the closest ER by a minimum of 45min to go direct to a hospital with interventional cardiology capabilities)
You tell me that I should contact medical control for these cases and I do if I have something vital to ask that Iím unsure of. I do know that I canít possibly know everything about everything there is to know about. I also, like probably a good number of providers out there am sometimes afraid to be found out as an idiot by asking a question that ďany idiot should knowĒ.
So there you have it. Like most people, Iím afraid to be found out as an idiot and itís keeping me from asking questions that may give me the appearance of being stupid and ignorant.
Unfortunately for my urge to go hide underneath a rock, I have a blog about EMS that I feel compelled to write something on every day. This means that eventually, Iím going to write something that is so stupid and ignorant about something that you are going to find me out for being an idiot. I may even ask a question about something that I should know by now and you may laugh at me for not knowing the answer to the question I ask.
So Iíve made up my mind. From now on, with you as my witness, I am going to be unafraid to ask dumb questions about things I should already know about. If I donít know something, Iím going to assume that thereís someone out there that doesnít know it eitherÖ and Iím going to write those answers down here on this blog just for that personÖ and for you.
I hope that maybe you might start being unafraid to ask those types of questions too. You never know what you might learn. The only cure for this affliction is to buck up and ask the questions, knowing full well that every single person out there feels the same way that you doÖ and is scared of being found out themselves.
Or you can come here and find out the answers that Iíve found out for you. Iím already a known idiotÖ no sense in you risking your own neck.
See you tomorrow, Folks.