Tricks of the Trade by Older Paramedics

After you have been a Paramedic for a few years you will have made mistakes and probably learnt from them. These are a few of the odd little tricks that I have learnt since I started as a Paramedic:

1. If you’re going to administer GTN (Anginine) to a patient who has never had it or another nitrate (the class of drugs used to dilate coronary arteries) before, try to get them onto the stretcher if this is possible before administering this. Obviously, you do not wish to delay nitrate therapy in a patient with suspected cardiac related chest pain; however, if it is the matter of a couple minutes, it may work out in your favour to wait and administer it to them once they’re on the stretcher. This is because, unlike elderly patients who may have had nitrates hundreds of times before, if you administer it to a person for the first time, they are very likely to have a significant drop in blood pressure, and end up either laying down, or unconscious. It is therefore much easier to deal with this if you get them onto the stretcher first.
2. If a patient tells you that they don’t have any previous medical problems whatsoever, ask them if they take any medications. Often, people don’t acknowledge that they have any medical problems, because they see the fact that they take medications for them, means that they no longer have the problems.
3. If you’re having trouble differentiating between pleuretic and cardiac chest pain, ask them to point to the pain with one finger – if they point to one specific spot and describe it as a sharp stabbing pain, it is most likely pleuretic in nature, if they point to an area, not a specific point, it is more likely to be cardiac in nature. At any rate, if you’re unsure at all, treat the patient for cardiac chest pain.