One thing that I learned as a resident in emergency medicine is that when a patient has cardiac arrest after a car crash, motorcycle crash or some other major trauma, those people are not going to do well.
In fact, it is rare for them to survive.
Of course, there are exceptions. One such patient was the victim of a high speed motorcycle crash into a large tree. When paramedics got to him, he was essentially dead. No pulse, no breathing. They got him intubated, started CPR, and headed toward the ER. Surprisingly, on arrival, he had regained a strong pulse and blood pressure. It was speculated that when he crashed, he was knocked unconscious, and because of how his body was positioned, he could not breath, perhaps because his face was against the ground, or something was pushing on his airway. Instead of developing cardiac arrest because of severe bleeding, head injury, etc, he had suffered a respiratory arrest, which was correctable. He ended up recovering, and proving there is always an exception to the rule.
We recently had a patient who suffered a cardiac arrest and was under CPR for quite some time, but regained spontaneous circulation and was brought in with decent vital signs. His mental status on arrival was very poor, however. He ended up getting treated with induced hypothermia, meaning he was chilled down with ice packs, and cold IV fluids. Despite the general consensus that he would do quite poorly, he ended up making a relatively dramatic recovery. I can’t say I’ve had much personal experience with this, but the data looks promising, and the American Heart Association is recommending it now. Would love to hear about more of these cases. As for me, if I have a cardiac arrest, I hope I’m skiing at the time.
The stock market stresses the heart and more
Q:
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Can anxiety from the economic meltdown cause a heart attack?
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A:
The fact that we are not seeing 1000 heart attacks per day probably means that this economic meltdown is not actually causing heart attacks directly. But are we seeing more anxiety problems and panic attacks? You bet! Any ER doctor will tell you that anxiety is a big component of our work, mostly because people get concerning symptoms with anxiety such as chest pain, trouble breathing, numbness, tingling, palpitations, and the like. It can actually be difficult sorting out which patients are just anxious and which ones have a true medical problem going on, and often times, some tests are in order.
I remember working in Los Angeles after the Northridge earthquake, and many people came in with severe anxiety, trouble sleeping, chest pain, etc. The financial problems going on right now are absolutely causing people stress, and we are seeing them in the ER regularly. I’m always happy when I can tell patients that their symptoms are not due to a major medical problem, but unfortunately it doesn’t do much for their financial woes. I also feel that stress, in general, can cause long term health problems, if not managed appropriately.
