Medical Admissions: Time is Thine Enemy

As some of you know, I've been off from work since the beginning of August to study for the Boards. Let me just say that it's been pretty dull, but productive. But since it's been pretty dull, there really hasn't been a whole lot for me to blog about.

However, since I work often in the ER, one thing I've noticed is just how little people know about what constitutes a medical emergency, and they were subsequently left with permanent disabilities (or died) because they didn't know to go to see a doctor in a timely manner. None of this is taught in schools, and in general, people don't go see doctors until it's too late.

So I'm going to start blogging about random medical stuff.

"Don't wait 'til morning" Symptoms

1. Chest Pain (12 hour window)
Not all chest pain comes from the heart. That being said, if it is a heart attack, you only have a 12-hour window to be given clot busters, to destroy that troublesome clot in your coronary artery. Once it's past 12-hours, we can't give the medication, and we move from treating the heart attack to trying to save the heart tissue that's left.

Angina classically is chest pain that goes to your left arm, neck or back, but I've seen people with simple chest pain end up ruling in for a heart attack. So if in doubt, go to the ER. If it's not a heart attack, the worst that can happen is you stay overnight in the hospital and you get to run on a treadmill the next day. But, if it is a heart attack and you don't go... Hrm, this sounds an awful lot like Pascal's wager. =/

2. Stroke (3 hour window)
If you or a loved one have signs of a stroke, call 911 immediately! Signs of stroke include sudden onset slurred speech, facial droop on 1/2 of your face, and/or difficulty walking. You only have a 3-hour window to be given clot buster medication. That is not a lot of time.

Remember, on average, it takes about 2 1/2 hours from calling 911 to ER to CT scan to clot buster. It can be shorter, and it can definitely be longer. So if you delay calling 911 by even 10 minutes, you may miss the window!

With the medication, most people have complete resolution of their hemi-paralysis. Without it, many people are left with permanent paralysis, and a whole bunch of quality of life and social issues afterwards.

This is what happened to my grandfather. He was living with my uncle at the time in LA. He developed sudden onset difficulty talking and walking. Unfortunately, having a doctor in the family ended up being a real disadvantage, because my uncle just figured he would take my grandfather to see my physician dad. Of course, by the time my grandfather arrived, it was way way past the 3 hour window, and he was left with permanent left-sided paralysis.

Afterwards, my grandfather was bed-ridden, when he used to be so active. He lost all his weight, and eventually needed a tracheostomy to breathe. He eventually died a couple years later, having spent the majority of his remaining time in a nursing home.

I sometimes wonder how things would be different now if he had instead gone straight to the ER. I couldn't save my grandfather, and the worst part was, it was totally preventable. Hopefully, when something like this happens to you or your parents (and it will: heart attack and stroke are still the #1 and #2 killers in the US), you'll recognize the signs, and make it to the ER in time.