Heart Attack!

[beenthere]

Just said good bye to a grand daughter who is 4th year med student. Today was first day of a 6 week "tour" of duty in Michigan in an ER ortho surgery. Says her understanding is expect 90 hours a week at the hospital. 
When asked about the 90 hours, said it was down from more hours to now the limit of 90. Be there, and ready to go at moment's notice. 

Can understand how that doesn't sound like "retirement" duty for the Doc's, and how important they are to us when we suddenly find ourselves in the ER needing medical attention. So necessary for our comfortable lives. Thanks Doc Henderson. Pray that you get a break soon.  

[doctorb]

High energy fractures.  These are called segmental because they have portions of the bone separated into segments from the proximal and distal fragments.  Undoubtedly an open injury.  Needs the OR.  Debridement of the wounds and an IM nail.  Was my wheelhouse as a trauma orthopaedist.  Lots of other bad things can happen here.  Arterial injury, nerve injury, compartment syndrome, infection and possible amputation.  Kinda gets your attention.

[customsawyer]

I for one am very thankful for the info that our Docs share. I really like how they can explain it with a crayon, so I can understand it. Having met both of them, I can assure the rest, that they are mighty fine folks in person too.

[doc henderson]

Yes Doctorb, we shipped that to a level 1 trauma center.  He was a very responsible 60 something guy, that ran into the back of a stopped dump truck at 60 mph.  the leg was all that was seriously injured, but for scrapes and cuts.

[JD Guy]

Having had to use the services of the ER departments more than I like to admit I, for one am extremely grateful for y'all's commitment and expertise. We are fortunate that we have a ER Doc that lives down the road from us and he has run interference for us more than once at our local Hospital. May God Bless each and every one of our Doctors and Nurses smiley_clapping smiley_clapping

[doc henderson]

Thanks JD and all.

[SwampDonkey]

Last week a coworker had a heart attack, not on the job. He had bad chest pains in the morning and went to the local hospital. He was waiting in the local hospital to be taken to Saint John regional 3 hrs south of here. 56 years old. He is a life long smoker.

[doc henderson]

Is he OK?  the majority of heart attack victims survive, but for the ones that have a fatal arrhythmia or major vessel blockage, "widow maker".  For some if the cath. or thrombolytics are soon enough, there is minimal or short lived damage.  It can be the best thing for some who then decide to loose weight, control blood pressure and diabetes, and stop smoking.

[SwampDonkey]

Not sure of his status, have not been in contact for about 2 weeks, when I saw him at work. He had just changed jobs. He's run a clearing saw for years. I'm sure he'll be fine, just not the same. He'll have to make adjustments I'm sure. He's not over weight, and has always worked hard.

[SwampDonkey]

Had an update today on my coworker. He had 3 stints put in and doing better, but hasn't his energy back yet.

[230Dforme]

Good evening

Came across this post, wasn't going to reply, but here goes, may help someone
I'm 64, have life insurance, thought I'd get an additional policy on myself for my wife if needed
Had to get some testing for new policy
Test came back with indicator for heart disease
My father lived till age 92, mother still alive 87
I figured the heck with it, I'm fine

Two weeks later I go to the local health center Monday morning
Doctor knew right away enlarged ascending aorta, was sent to cardiologist same day
If that goes your done right there, no real need to call 911

Surgery scheduled, need dental release first
Go to dentist for cleaning and release
Infection, off to maxiofacial surgeon, 10 teeth out
Infection probably cause of heart issue
Heart surgery rescheduled

Surgery May 23, new aorta section, artificial valve, 12 days in hospital
All is fine

Point of all this is that had I not gone for policy or not gone to health center, would just have been a matter of time

If this post helps even one person it will have been worth sharing
Thankyou

Final comment for background
I am physically fit, owned a union structural steel erecting company and worked
along side my guys, do tree work now in my retirement 😳

[beenthere]

Thanks for sharing.

[Walnut Beast]

Glad you're ok! Thanks for sharing also!

[JJ]

Last July my son crashed an electric skateboard at about 30mph, road rash, broken leg, and cracked helmet.
This was result:



 

The 2 long screws between fibula and tibia were to allow ligaments to regrow.   Doc says they didn't need to be removed.   Now 5 months later he is doing PT exercises in a chair, rotating foot this way and that and when he bend in direction of the break, now he feels like something broke and is back in the foot brace.

I try to get him to go to emergency, not sure maybe one of the long screws broke -but he will not go and is waiting on his next PT appointment.   What could go wrong? should I insist he go, he is 22 years old.
I recall his orthopedist surgeon saying sometime the screws have to be removed by surgery, but most people don't.

How can the bones move properly with what looks like deck screw HW between them?

        -JJ

Thanks in advance for any advice from the Doc's

[JJ]

PT for my son ended up being a doctor's visit.
They say it is likely a tissue tear, which is a setback but should heal with some time.
Will monitor it for next week or so, using the boot in meantime and resting the foot.

He sold his E-skateboard with FAFO lesson learned.

     JJ

[doc henderson]

great.  not much we would do other than an x-ray and tell you to see the ortho doc.  all that takes time to heal, and PT helps you push strength and flexibility without injuring it more or again.  He is young and will hopefully heal up.  Chicks dig scars, or so I am told. :D

[doc henderson]

OK so not a heart attack, but it causes chest pain and soreness of breath.  It is the most under diagnosed life-threatening condition.  It can have a genetic predisposition.  It increases with weight, estrogen, sedentary life or long travel seated.  It can be instantly fatal.  It can be treated with blood thinners.  If severe it can be treated in the cath lab.  this is blood clots to the lungs call pulmonary embolus.  A clot forms in the pelvis or thigh are and propagates (grows) until a chunk breaks off.  It can be so big it lodges in the pulmonary artery where it divided s into L and R lung.  this is called a saddle embolus as it blocks all blood to the lungs straddling the divide.  hard to live.  or it can be hundreds of tiny clots called shoers of emboli and can be fatal if it lodges in branches of the arteries as they get smaller.  Note the tree language and anatomy.  Nature.  We can do a test called a D-dimmer.  It goes up with extra clot.  It can be falsely high and not represent clot.  with age or surgery, it is more often high falsely.  It is only really helpful if it is low and virtually rules out a blood clot.  If high, then you need an ultrasound of the large veins in the legs or a CT angiogram of the lungs.  This former Navy man went to the cath lab to have the clot removed by suction.  the black is the clot, the white is the pulmonary arteries, the color is reversed as it is easier to see. 

 

sorry could not find the flouro pic.  this is better.  a paper worksheet with the actual clot laid out as it came from the lungs.  

[doc henderson]

here is a recent MI.  came in in chest pain.  in cath. lab at 20 minutes. 





above you can see the inverse color on flouro and the area with contrast is dark and the area with clot, (no contrast in the vessel) is light.





The clot was removed, and the area blocked is reduced.



above the stent is in and you can barely tell there was a critical blockage.  pt. doing well.  you can see the wire being retracted at the lower R screen.

[farmfromkansas]

Learning things here.  Was able to see the blockages.

[doc henderson]

@JJ I have seen this done and it is more like a splint or internal "casting" to stabilize the area so the ligaments can heal.  those screws can be removed but over time they break between the bone and limber things up.  some will actually come out the other side, so when they break, they can each be removed.  I think they leave them unless they are causing pain/problems.  @doctorb

[WhitePineJunky]

Thought I had a big heart attack yesterday, spent 13 hours at the ER mostly waiting, 2 blood samples, ecg, X-rays ... nothing, they believe it was a esophagus spasm, very intense sharp pain under left collarbone, intensified with movement or panic but if I sat in just the right position it would alleviate, overall the pain lasted off and on 8 hours

I thought it's a little strange of a spot to have esophagus pain but I'm fine now

Ever see anything like that doc Henderson ?

[doc henderson]

every dam day I work.  the nerves from the heart and other nearby structure run in the same bundles.  it is good if the pain is reproducible meaning you can do something to make it worse or better, like a deep breath (pleurisy) or push on the chest (costochondritis) or move your arms 9chest wall pain).  gastroesophageal reflux mimic a heart attack pretty well.  bread and butter ED medicine.  If you were having a stemi, it would likely show on the first EKG, and you should be in the Cath lab in 20 minutes.  since it did not, they did two troponins, to see if they are going up (if initially normal) and if not bye bye.  If they are or you have a history of CAD, or other risk factor like DM, HTN, they would reamend a stress test or admit for repeated tropies and a possible heart Cath next day.  glad you are ok.

[WhitePineJunky]

every dam day I work.  the nerves from the heart and other nearby structure run in the same bundles.  it is good if the pain is reproducible meaning you can do something to make it worse or better, like a deep breath (pleurisy) or push on the chest (costochondritis) or move your arms 9chest wall pain).  gastroesophageal reflux mimic a heart attack pretty well.  bread and butter ED medicine.  If you were having a stemi, it would likely show on the first EKG, and you should be in the Cath lab in 20 minutes.  since it did not, they did two troponins, to see if they are going up (if initially normal) and if not bye bye.  If they are or you have a history of CAD, or other risk factor like DM, HTN, they would reamend a stress test or admit for repeated tropies and a possible heart Cath next day.  glad you are ok.

I believe Lyme disease left me with costro, I get pain around my lower ribs when I lay down for awhile, hurts a lot more if I lay on my sides. If i sleep at a 45 it's mostly gone. But that's in my mid/upper back area. What I felt a few days ago was pretty scary 

It's a good thing if you can reproduce pain or make it better? Is a heart attack something you can't make better or worse by sitting in certain positions? 

[WhitePineJunky]

The pain happend about 2 years ago as well, it lasted about 30 mins last time and this time I felt it for 8-10 hrs

[doc henderson]

typically.  If you are pushing hard enough to increase pain in your heart, you are breaking ribs.  If movement or pressure makes the same pain worse, then it is in the chest wall.  arm movement takes muscle movement and ligaments, not blood flow, so if that hurts, then I ask what did you do yesterday that was more strenuous than usual.  If they say they have been helping their whomever move, and the ekg and tropi is normal, and they are 25 years old, off you go.  If you have a headache and tell me it is a migraine cause it is so bad (a vascular headache) and I have you rub your scalp and neck and it make the headache, feel better or worse, then you have a tension headache from the platysmas muscle under your scalp.  next you have the bony skull and then the brain.  you cannot push hard enough on the skull to make a brain tumor, or bleed or migraine hurt worse.  You have to be careful and combine the physical exam with the history ect.  these are just examples we use daily.  Eating spicy food does not usually give you a heart attack, but it might flare up your gastritis.  hope that helps.  just like a good heating and air guy can look at the picture of your A frame froze up in your AC and say that is not low freon, that is low airflow.  sure enough, clean the filter in my shop ac.