Don't let me have a heart attack in Puerto Escondido

Well, this was an "exciting" day...Sara & I were with one of the doctors just seeing patients rather smoothly when we were all called into the IV room to help with a patient who was unresponsive.  

(For those readers who aren't in the medical field, you can just skip to the pictures as this following part may not be interesting.)

So, she was spontaneously breathing (although it was kinda agonal at times & she definitely had an upper airway obstruction), and she did have a heart rate, so no CPR needed yet.  Glucose came back at 248, and her BP was 175/100'ish.  Pupils non-reactive, but small.  Breath sounds clear & HR tachy but strong & regular.  

As we continue the assessment & try to figure out what's wrong (other than her hypertensive urgency), Sara says, "I think she's having a seizure," and sure enough eye twitching, then tonic-clonic little 'ole seizure for about 1 minute.  We had no oxygen, and the only IV/IM benzo we had was expired.  So, we just watched...kind of a long 60 seconds, you can imagine.  

Afterward, we needed to clear her airway, so luckily, this little primary care clinic we were at had suction...but not what you normally think of...they handed me a bulb suction device (like what you use to clean out a baby's nose!)...but it did come in a sterile package, lol.  

But the part that really made me cringe was when the lack of IV meds warranted the use of oral medications that were crushed & dissolved in water, then squirted down this unresponsive woman's throat.  Sara & I both asked, "ummm...is that really going to work?"  The staff responded basically with "Well, do you have a better idea right now?"  Sara & I backed down, lol.  

So, we decided to call an ambulance to take us the 10 minutes to Puerto's hospital.  They don't have paramedics, so the Dra., Sara, and I went with the patient assessing her throughout the trip.  As you can see in the pictures below, there was NO equipment on-board.  

But we did make it safely to the hospital.  She seized again as soon as we got there, but stopped fairly quickly.  We were able to truly suction her airway (good job, Sara!) and get some oxygen on her.  12-lead EKG revealed an inferior wall MI and there was a lot of intermittent ectopy with frequent bigeminy.  

I was told she was later shipped out to Oaxaca for higher level care since Puerto doesn't have an ICU.  We later found out that she lives alone and doesn't do anything to control her HTN or diabetes.  Speaking of higher level care, it's important to know that only 3 cities in Mexico have hospitals which place cardiac stents.  So, please, God, don't let me have an MI in Mexico.  

Although I hate it for the lady, I got to be a paramedic and sort of an ER doc today.  It was a good learning experience for me.