EMT's, Nurses, Doctors, I need help !

This is a discussion on EMT's, Nurses, Doctors, I need help ! within the Off Topic & Humor Discussion forums, part of the The Back Porch category; My wife was diagnosed with "atrial fibrillation" a couple of months ago and she is at high risk for a stroke and other related "inconveniences". ...

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Thread: EMT's, Nurses, Doctors, I need help !

  1. #1
    Distinguished Member Array jfl's Avatar
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    EMT's, Nurses, Doctors, I need help !

    My wife was diagnosed with "atrial fibrillation" a couple of months ago and she is at high risk for a stroke and other related "inconveniences".
    She was recently put on anticoagulants, Coumadin (warfarin - rat poison ) and Lanoxin (digoxin).
    We were told to advise medical personnel of these medications if she needed urgent care; she is a very active person and my job as a corporate pilot keeps me out of town at times.

    Questions:

    - Are these on-line "Emergency medical information services" of any interest; I saw ads for "Medicalert.org", at $27 per year, it seemed pretty reasonable.

    - Since the dosage of Coumadin is not established yet, and I was told it was an important information, the engraved bracelets won't work.
    I was thinking of a card like these ID tags people wear in secure areas; would such a card be of any value for the emergency personnel ?
    - Any specific format ?

    - Any other suggestions ?

    Your input is greatly appreciated !!!
    ____________________________________________

    Why do I post this on DCC ?
    Because of the immense collective knowledge of this group, the fact that there are people from all occupations including some well experienced in emergency response, and also having been around this site for a good while, I really feel I have friends here.
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  3. #2
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    Hmmmm, my FIL just moved in with us due to age AND having afib, the Coumadin, according to his cardiologist is his most important med since it will likely prevent clotting problems. BTW the cardiologist is pretty sure his sleep apnea was triggering the afib events, he now has had a cpap machine for three months, and hasn't had an afib event yet (FWIW)

    I don't have any experience with the MedicAlert, my Dad did wear one of those "help I've fallen and can't get up buttons" and it worked pretty good and was about $30 per month. As you know it only summons EMS or whoever. Some related hints I can think of:

    1. Enter ICE in her cell phone directory, it's possible it could help, it sure can't hurt. You could enter ICE MedicAlert as one also.
    2. Some agencies give out "File of Life" or some similar label to put on the door. If EMS shows up they go to the frig and look for a pouch stuck on the frig which contains a card that you keep updated with her medical info. Check with you local EMS service.
    3. Also you can hide a house key outside somewhere and the fire department can enter the hiding place in their computer and be able to let themselves inside in an emergency. You can also get an exterior lock box (like on new cars at the dealer) the fire dept has a key to open it and have access to your house key.
    4. Have a copy of her EKG in the event you have to go to the ER, you/she/medicalert fax, can hand it right to the doc and save some time. My FIL's cardiologist gave us a signed by him copy just for that purpose.
    5. If I get it right with the MedicAlert she wears a bracelet that refers a number for EMS or ER to call and obtain her medical info? That sounds good in your case that you are away a lot. Of course you'd have to keep it updated, though for right now I wouldn't worry too much about the dosages, just the fact that you post "coumadin" is a BIG help to docs (IMHO).

    I hope this helps
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    VIP Member Array semperfi.45's Avatar
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    It's been a while since I ran on a medic truck, I recall never looking for a card. The police are the ones that find a card if your unconscious and they look to ID you by looking through your wallet.

    The coumadin dosage won't matter and the medics will realize it with A-fib on the monitor and they will see thin blood when they start an IV. I still think the protocol is to load Digoxin into the patient and since the prescription Dig on board already isn't working, it's dosage would be nice to know but won't matter in the field. Treatment is with some other meds and persistent unstable A-fib gets cardioversion.

    So my advice is; if a patient with a cardiac history needs to wear a medical history card it should be a current laminated card that is worn around the neck. The card will be revealed when the chest is bared for a 12 lead EKG and will be harder for EMS to ignore if it's staring them in the face.

    Info on the card should be pedigree info, meds taking and dosages, pertinent medical history and at least 2 emergency contact numbers.
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    Distinguished Member Array Arko's Avatar
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    When I was a paramedic, we didn't make it a point to search for wallet cards or bracelets for a couple reasons: It distracts from primary treatment, they aren't always up to date, and whatever is presenting may be co-commitment with or secondary to, another issue.

    If a patient is unconscious, or unable to communicate we were usually focused on the basic life support issues (Airway, Breathing). When we hook up a cardiac monitor, assuming there is still a pulse, we let what we find at the moment guide treatment and communication with the hospital. If a person had severe a-fib that it can trigger another arrhythmia that needs attention as well. If not, then the a-fib itself would be identified and treated/communicated, hopefully...

    In short, unless you're somewhere it's a long haul to the ER, the alert products might not be found or come into play before she's at the point of definitive care.

    Far more important, IMO, is ICE (in case of emergency) contact info somewhere on their person, or in their phone under ICE in contacts. It's not easy locating family from a driver's license....
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  6. #5
    Distinguished Member Array Arko's Avatar
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    Quote Originally Posted by semperfi.45 View Post
    It's been a while since I ran on a medic truck, I recall never looking for a card. The police are the ones that find a card if your unconscious and they look to ID you by looking through your wallet.

    The coumadin dosage won't matter and the medics will realize it with A-fib on the monitor and they will see thin blood when they start an IV. I still think the protocol is to load Digoxin into the patient and since the prescription Dig on board already isn't working, it's dosage would be nice to know but won't matter in the field. Treatment is with some other meds and persistent unstable A-fib gets cardioversion.

    So my advice is; if a patient with a cardiac history needs to wear a medical history card it should be a current laminated card that is worn around the neck. The card will be revealed when the chest is bared for a 12 lead EKG and will be harder for EMS to ignore if it's staring them in the face.

    Info on the card should be pedigree info, meds taking and dosages, pertinent medical history and at least 2 emergency contact numbers.
    I guess we were both typing at the same time.
    Good advice Semperfi.
    That just about covers it from a field perspective.
    I'd sum up by saying if you are going to use a card, or a list, make sure it's up to date with med names spelled correctly and dosages.
    Last edited by Arko; May 25th, 2009 at 07:57 AM. Reason: grammer
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    VIP Member Array Cupcake's Avatar
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    I'll support that we didn't often look for bracelets and almost never did we look for wallet card in the field. While not 100%, we were more likely to notice a necklace because it's kinda right there when hooking up the cardiac monitor. I've never seen one in the field, but I recall seeing a medic alert necklace that was actually a little vial that could hold some info. Not as obvious as a card, but more likely to be worn by some people. It would almost certainly be found by hospital personell, if not pre-hospital. Certainly helpful to have the list of meds, but I can't imagine great need for dosage info in the first 12-24 hours...but it can't hurt.
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    Distinguished Member Array jfl's Avatar
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    Thanks guys, many thanks !!!

    Always good to know how the people in the field operate.
    The first rule of a gunfight: "Don't be there !"
    The second rule: "Bring enough gun"

    jfl
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    I am not a medical person at all, but i just wanted to say good luck to your wife with managing her condition if it's something she has to live with, or else "get well soon" if it's something that will go away. Either way, I hope she feels better and whatever it is, it's not going to be a recurring issue for her. Please give her a hug for me :)
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    Distinguished Member Array jfl's Avatar
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    Quote Originally Posted by Bunny View Post
    I am not a medical person at all, but i just wanted to say good luck to your wife with managing her condition if it's something she has to live with, or else "get well soon" if it's something that will go away. Either way, I hope she feels better and whatever it is, it's not going to be a recurring issue for her. Please give her a hug for me :)
    Thank you so much, Bunny !!!

    No, it is pretty much a permanent condition, but a-fib is not very dangerous per se, it is the associated high risk of a stroke that is scary.
    When you have lived happily with somebody for 37 years and she's the only family you have left, and you wake up in the middle of the night and check if she is still breathing, it is hard ...
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    The second rule: "Bring enough gun"

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    My wife takes Coumadin for a different condition but is also a stroke waiting to happen. Coumadin is a funky medicine for which you are unlikely to find a single dose that your spouse can stick with. Probably, your wife will need to have her INR checked with some frequency to adjust the Coumadin dose as needed. There are just too many dietary and other factors that cause the INR to constantly be in flux.

    For this reason, I don't know that she needs to keep her current dose on her. She does however need to be able to somehow inform EMTs and ER docs that she is on Coumadin for AF.

    Medic alert is reasonably priced and their bracelet with AF and Coumadin on it should work; as would a necklace. My wife doesn't leave home without that bracelet.

    I am a bit surprised that a couple of EMT folks said they didn't actively look for these.

    If you want to PM me, I'd be happy to share.

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    Senior Member Array ErikGr7's Avatar
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    My dad has had several heart attacks in the past and
    is now on Coumadin.

    It thins your blood. He can just bump his hand and
    it causes a bruise now.

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    Heads up Erik-- don't ignore the bruising except on doc's ok

    Quote Originally Posted by ErikGr7 View Post
    My dad has had several heart attacks in the past and
    is now on Coumadin.

    It thins your blood. He can just bump his hand and
    it causes a bruise now.
    Your dad's doc will have picked a target INR range for your dad, and the doc should be having your dad's blood checked periodically to make sure that the Coumadin effect is having the specific target effect on clot formation.

    While it is certainly possible that your dad's doc has deliberately chosen a dose which is sufficiently high to cause easy bruising, it is also possible that your dad is either not being properly monitored or is mistakenly taking more Coumadin than he should be taking. Or, perhaps your dad is not following up on recommended lab. tests.

    If your dad's doc is not having him routinely get his INR checked, your dad should talk to the doc about the bruising and whether or not more close monitoring would be appropriate.

    The easy bruising is a danger signal which should not be ignored except on advice of his doc.

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    Senior Member Array ErikGr7's Avatar
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    Well they had him on plavix and then Coumadin. He had
    a stint put in awhile back and they wanted his blood to
    be thin until the skin grew over the stint in the artery and
    could hold it in place.

    I know he gets his INR checked. I haven't asked him
    about the bruising lately.

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    VIP Member Array semperfi.45's Avatar
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    Quote Originally Posted by Hopyard View Post
    I am a bit surprised that a couple of EMT folks said they didn't actively look for these.
    Sorry, that seems to be the way it goes pre-hospital where the emergency is addressed. As said before medic alert info is more important at and for the definitive care source.
    Training means learning the rules. Experience means learning the exceptions.

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    I probably would not spend the money on medicalert. It is imperative that medical personnel know she is on warfarin, the dose is completely unimportant, at least in the acute setting. I assume she will also take other meds such as Digoxin. Again, very important to know as there are significant interactions with other meds.
    Good luck and be well.
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