Correct Response to this?

[Rosemary349]

Hi Everyone

Wonder if you could help me on something I've been thinking about a lot lately.  I'll explain afterwards, but I'd really appreciate your views and if your a medical professional also it would be great if you could let me know.

Scenario:  You are on the other end of a helpline for medical care.  Someone phones in, a 64 year old male relative has had indigestion for 12 hours now and they are concerned, he's also going hot and cold and showing stomach distension.  He won't eat and is belching constantly.  He is otherwise walking around and seeming ok.  Is pale and clammy.  No chest pain but an ache right across diaphragm.  No history of heart problems.

What do you think should be the most appropriate course of action in that situation?

Thanks for taking a look at this.  :-)

[Rosemary349]

I am sorry to hear about your mum, it's coming back to me now, this was something you mentioned before.

I think at some point for our own health and sanity we have to accept.....and I will, I channel it all into supporting the BHF, etc.....but I will do whatever I can to see to it that medical people make better decisions, because heart disease has been around long enough now!  They should be able to do better than what they did with my dad (which was to tell him to take more gaviscon as this 'doesn't seem like a heart related problem.')

Still, it doesn't help to harp on about it - I was just trying to work something out in my head about it all.  Dad's symptoms were not classic textbook ones, so I was wondering what informed people (though not necessarily medical) would do.  

Clearly he'd have been better off with the advice of you guys!

[ed34]

Many have haunting skeletons in the closet. My Mother was taken into hospital 10 years ago with shortness of breath. She passed numerous tests including ECG and they diagnosed a bad chest infection. At around 2am I left her in the 'capable' hands of the medical teams. Six Doctors had seen her. I returned at 8am to be handed a bereavement leaflet. Her heart had stopped several times and they couldn't keep reviving her. If I knew then what I know now, I can assure you there would be a very different outcome. It does haunt you, and I don't think it ever goes away.

[Rosemary349]

Thanks for tolerating me on this one and your patience.  I wanted to know your opinion on what was the right action and it appears you agree with me on this one, I believe the person needs checking out at hospital.

Unfortunately this was my father, on a Saturday evening.  He died on the following Monday evening of a ruptured MI.  The medical reports strongly suggest that this was an MI that was treatable on the Saturday and that had he gone to hospital he would most likely have survived.  The heart ruptured on the Monday because it had been almost three days without treatment.

Ed34, I remember you because you responded to one of my initial posts...4 years ago just after it happened.  I'd asked what it felt like to have a fatal MI...or something like that and you said how could anyone know.  Then someone pounced on you for being insensitive....but actually it was a daft question and you and I sorted it out, lol.  You were in fact very helpful on a lot of issues, so hope you don't mind me bringing this up but thought it might jog your memory.

yep I'm still thinking this all through 4 years later.

[Flycaster305]

I agree with Ed totally.  If it was a situation of bad gas, so be it, but vitals can determine that at a good hospital.  For example, if blood tests show what is called a 'left shift' is happening where immature white blood cells/antibodies are present, there is a serious infection going on.  Blood tests also will show if it is cardiac related.
Let us know the reason for this excellent post, and the result.

[ed34]

Ambulance and hospital.

[Rosemary349]

that is, if you think any medical decision or action should be taken at this point?  Or perhaps you don't think that's necessary?

Flycaster305, so sorry to hear what happened to you, glad you have recovered from that.  I'll talk more once everyone's considered the question....if you can....appreciate it :-)

[Rosemary349]

Thanks so much for your responses....I have thoroughly read them and appreciate them but I just want to ask one more thing before discussing.  

I'm keen to know what you think the most appropriate course of action in this situation, not necessarily what you think it might be.  What, medical decisions, in your opinion, should be made at this point?

I really appreciate this and I promise I will get back on this.  

[Flycaster305]

Not necessarily true, at least in my case.  I didn't throw up until 18 hours after the first symptoms, but when I did, it contained fecal matter and the force of the vomiting destroyed my LES valve which contains stomach acid to the stomach, and had to have surgery to correct that problem as well as surgery to correct the bowel obstruction.  You are right, the pain was intense.  I had what is called a double bowel obstruction, it was obstructed in two places, quite rare.  The higher obstruction was a wayward ribbon of fat that wrapped around the intestine, the lower obstruction was scar tissue from what was probably my poor defense when I was a boxer many years ago. Regarding angina, partial blockages can and do cause pain for literally days, and when controlled with nitro pills or spray, can be managed.  Also, gall bladder issues can cause the symptoms Rosemary talks about.  Rosemary, let us know?  I congratulate you on a most interesting post.

[Occupant]

If it was a bowel obstruction - unless it wasn't total - he would have thrown up way before the 12 hours were up and be in the emergency room. The pain is just unbelievable.

[ed34]

Not a health professional but this is exactly the kind of case which causes confusion. I do however have to question the 12 hour part. I can't see a heart attack lasting that long personally. Surely the heart muscle would have died before the first hour was up and stop producing pain? It could be a bad case of Angina though where some blood is getting through. From the symptoms it doesn't sound like it's cardiac related to me. Perhaps lots of trapped gas aggravating the vagus nerve?
I suppose you are going to tell us this person died of heart failure :(

[Flycaster305]

I'm not a health professional, sorry, but having phoned a helpline with similar symptoms...
I thought I was having a heart attack again when I called the nurses who monitor my health insurance hotline.  I was told to check my blood pressure, which I did, while the nurse was on hold, probably to a supervisor or doctor.  My blood pressure was quite low, which I reported, and was told to call an ambulance, I was either having a heart attack, a serious gall bladder problem, or maybe a bowel obstruction.  It turned out to be a bowel obstruction as well as angina (I have a hx of heart problems, and the on-line advice probably saved my life.  I had surgery for the obstruction with a cardiologist standing by... hope that helps.