Re: New Question - Thrombolytics

November 9, 2001

All,

Are there that many 'cardiac' incidents occuring to warrant the use of

Thrombolitics ? In my 8yrs offshore I think I have encountered only four

seperate incidents. 1 of those was a chest pains, sent in and an MI

diagnosed, (could have used thrombolitics but no defib available let alone

a 12 lead) 1 a collapse ONSO, (no evidence on defib / monitor) query silent

MI turned out to be viral and 2 who were on the rig one day and either dead

or in hospital the next. The last 2 could have occured offshore but didn't.

Hopefully we have a relatively healthy workforce offshore in the UK because

of the screening thats in place, more to come if legislation is being

pushed but I cannot say that same for other 'foreign' parts.

Tim

November 10, 2001

Chaps re thrombolytics in remote locations. I have dealt with only two such

cases 1 whilst in Kazakhstan and 1 in N Sea.

Kazakhstan

Gent came with vague symptoms. Thorough history taken coupled with age and

lifestyle lead me to consider either angina or MI.No other medical history or

symptoms plus remember this chaps my intincts were telling me this was cardiac!

Also one other point to note he had a thorough medical before coming out to the

project 5 weeks before including ecg! and was passed fit.(50 heavy smoker etc

and family history of cardiac disease)

No ecg available as it was US and being serviced in UK. Defib available and ecg

diagnosis completed by some colleagues who were Czech Doctors so Medevac

required. 3 days from initial consultation to evac!!!( stress unbeleivable!)

Remote? not half! No extension of symptoms as pt kept under close obs, allowed

only to leave accommodation to go to canteen by car and back.(Land based

operation) and given aspirin as per max dose in any other case i.e. x2 300mg

QID.As no precluding conditions present.

Survived stay and evacuation to London to have surgery after angiography for

bilateral carotid bypass and quadruple cardiac bypass.!! WOW!

N Sea

Called to sickbay to see Gent again 50's history of onset of chest pain and

feeling generally rubbish also sweaty and mildly breathless. Non smoker and no

family history.

Initial impression was of ongoing MI.(plae sweaty and looked terrified)

Followed protocol of rest O2 Iv cannulation, and GTN spray initially with

morphine to follow and monitor whilst urgently contacting Dr who was on linked

platform to attend ASAP. In the menatime ran off a rythm strip with no major

abnormalities to the almost lay person(me!)

DR came and assessed. As my treatment of o2, and analgesia had reduced sympotoms

and distress Dr did not agree with my diagnosis ( he did have an attitude

problem. We also had thrombolytics on board as it was Physician supervised and

supported project.)

Dr decided to allow pt to go back to his single cabin as it was Oesophageal

spasm. We had a ward and I was on nights so obs and monitoring would have been

no prob. Consequently when went to review pt 4 hours later he was found in his

cabin on floor face down he had died trying to phone for assistance. So even

having thromblytics and a DR can be useless.

At PM chap had died of Massive MI. I would like to have seen him heading for

Aberdeen on a helicopter for a chance but when a Doc tells you not to be so

dramatic and you were fairly wet behind the ears what do you do?

Not now folks I am a bolshy cow if I instinctvely feel that it's serious and

I'll stand up for my patient so they can get help.

TTFN Kim Dellanzo-McHardy (still loooking for work so keep me posted folks!

available after 23/11/01)