Ischaemic heart disease

Outback nurse self manages STEMI

When it comes to health care, they do things differently in the Aussie outback. And despite being on the coast, a gateway to Ningaloo Reef and diving with whale sharks, Coral Bay in WA qualifies as outback.

So when the local nurse presented to his own nursing post with severe chest pain and dizziness, performed his own ECGs and self-administered aspirin, clopidogrel, sublingual nitroglycerin, intravenous heparin, and opiates…well it was worth a write up in the NEJM.

The 44 year-old male nurse was able to access support from an emergency physician via the Emergency Telehealth Service (ETS) and some local St John’s Ambulance volunteers.

Preparations were made for thrombolysis with tenecteplase, with real-time video interaction with the ETS.

However the nurse also self-cannulated both antecubital fossae for IV access, prepared the adrenaline, atropine, and amiodarone, and attached his own defibrillator pads.

According to the NEJM article, the patient’s first ECG revealed complete heart block, right bundle-branch block, hyperacute T waves in the inferior leads, and reciprocal ST-segment depression in the anterolateral leads.

“The second electrocardiogram, obtained 50 minutes later, showed sinus tachycardia with 2 mm of inferior ST-segment elevation,” they wrote.

“After thrombolysis, there was resolution of his ST-segment elevation and symptoms.”

The Royal Flying Doctor Service eventually transferred the patient 1,000 km south to a tertiary cardiology unit in Perth where he received a drug-eluting stent, and residual coronary artery disease was managed medically. He was discharged 48 hours later.

“In the absence of other trained medical personnel or resources, the actions of this patient are likely to have had a substantial beneficial effect on the clinical outcome.”

“However, a person’s self-management of a myocardial infarction cannot be considered medically appropriate if any other option is available,” they added.

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