LENMED AIR 2019.pdf

LENMED’S FIRST DEDICATED CARDIAC RESPONSE VEHICLE Lenmed’s rapid response vehicle is staffed with an advanced life support paramedic and can treat cardiac stroke patients pre-hospital. Janus van Schalkwyk, an Advanced Life Support Paramedic at IPSS, recounts an experience in the high-tech response vehicle. On the 23rd of November 2018 at about 12:30 in the morning, I was contacted by a family doctor situated in St Lucia tourist town, 230 kms north of Ethekwini Hospital and Heart Centre. She was with a 66-year-old male patient complaining of centralised chest pain and presenting with hypotension and shortness of breath. Being in a very small and secluded town, the only diagnostic equipment that the doctor had with her was a blood pressure cuff, an oxygen saturation probe and a stethoscope. She had sited an intravenous line and was administering fluids in an attempt to manage the hypotension. She had also administered aspirin to the patient. Unfortunately on that day there were no aeromedical services available. exacerbate his condition. I started responding in their direction but was 200 kms away. Once the ambulance arrived on scene, they assessed the patient and noted ischemic changes on their 5-lead ECG. The crew was able to confirm the doctor’s suspicion of acute coronary syndrome. The patient was loaded into the ambulance, treatment initiated and mobilised south in the direction of Ethekwini Hospital and Heart Centre. I made contact with the ambulance 20 kms south of St Lucia on the side of the road. I took over management of the patient and the treating crew would then follow us in my response vehicle back to the hospital. A 12-lead ECG clearly indicted a STEMI or full thickness myocardial infarction. The patient’s vital signs, along with the 12-lead ECG, were transmitted via a live feed for the cardiologist on call, Dr Soosiwala. After consultation with the cardiologist, we agreed that due to the prolonged distance to hospital and the severity of the myocardial infarction it was in the best interest of the patient to administer a thrombolytic drug called Metalyse. Thrombolytics are essentially clot busting drugs that, when administered to patients that are experiencing a myocardial infarction, break down all clots throughout the body, including the clot responsible for the infarction. These drugs are generally used by smaller hospitals where there are no angiograms or cardiologists available as part of the emergency management of acute myocardial infarction (AMI) patients. Even though this drug is extremely effective in reversing the effects of a heart attack, there are some inherent risks and should only be administered to patients where the benefit of the drug outweighs the risks involved. Several studies have recently highlighted how effective this drug is in the management of heart attacks in the pre-hospital environment. Metalyse was administered to the patient while in transit to hospital. Ongoing serial ECGs were completed while the cardiologist was continuously monitoring the patient from 200 kms away. Chest pain started to decrease 30 minutes after the drug was administered and ECG changes evident of cardiac reperfusion were noted shortly thereafter. The patient arrived at Ethekwini Hospital and Heart Centre two hours and 15 minutes after leaving St Lucia. By that time the chest pain had completely subsided. After an assessment by the cardiologist, it was decided that an emergency angiogram was no longer required and that the patient was to undergo a diagnostic angiogram the following day. The administration of Metalyse completely dissolved the clot and the patient was discharged three days later without receiving a single stent.” One of our more northerly located ambulances was dispatched to her location but would take at least 40 minutes to reach her. The doctor was reluctant to move the patient as she was worried that the stress and workload of walking down two sets of stairs would increase cardiac oxygen demand and LENMED ANNUAL INTEGRATED REPORT 2019 05