Physician, heal thyself
Imagine you were the only healthcare professional on duty. The next nearest medical facility is 100 miles away. The nearest major city is 600 miles away. For those of us working in the NHS, it’s hard to think of many areas of the UK where this might apply but for our colleagues working in Western Australia, this may well be their day to day reality.
So back to our imaginary scenario. Picture yourself, in the Highlands, in Western Australia, or perhaps on a plane over the Atlantic Ocean where you are the only medically qualified passenger. There’s no expert team to fall back on in the event of a medical emergency; here, it’s just you, and your skills. Now imagine, there is a medical emergency. A patient, or a passenger, with severe chest pain; they appear peri-arrest. Now imagine, that the patient, is in fact, you.
It seems implausible, but this is the exact situation that a 44 year old nurse from Coral Bay, Australia found himself in. In a letter to the editor of the NEJM entitled Self Management of an Inferior ST-Segment Elevation Myocardial Infarction, the authors describe exactly how this clinician went on to manage their own medical emergency.
Owing to my excellent nursing colleagues I am a little embarrassed to admit that it has been years since I have had to try and take my own ECG. Could you, whilst peri-arrest, take your own? This nurse did and managed to email them to an emergency physician. These ECGs show that he was actually in complete heart block at the time. And having an inferior MI.
He managed to self cannulate himself in both ACFs, no easy task. He took aspirin, clopidogrel and sublingual GTN before giving himself IV heparin and opiates. Can you imagine having to draw up your own emergency drugs for yourself, praying you wouldn’t need them? This nurse had to draw up his own adrenaline, atropine and amiodarone. Then, he attached his own defib pads, and gave himself thrombolysis.
Amazingly, he survived. He was transferred by the Royal Flying Doctor Service and underwent an angio the next day (which showed a severe stenosis in the RCA). It is an incredible story, and I can’t find anything like it in the literature. I wonder if I would have had the courage or skills to save my own life in a similar situation.
Good Sir, I salute you.
Self-Management of an Inferior ST-Segment Myocardial Infarction. N Engl J Med 2018; 378:960-962