Myocardial-infarction

Cardiac distress symptoms in women

In the wake of Carrie Fisher’s death four days after she suffered a massive heart attack, one thing that was reported by some news outlets was that she had been in “significant distress” on the flight. We don’t know the exact details of this, but in my experience as an EMT, it often means “hysterical woman having a panic attack and thinking she’s dying…*woman dies* …oops, guess she really was dying.” 

It is SO IMPORTANT to remember that many women present in what medicine considers an ‘atypical’ manner for heart attack, but it actually IS typical…for women. Women are more than twice as likely to die from cardiac emergencies, not because our physiology is that much different than men and thus gives us a worse chance at survival (it’s actually better if treated promptly and adequately), but because our symptoms are more likely to go unrecognized or to be dismissed entirely.

Thus, please take a moment to review and pass on this list of cardiac distress symptoms as seen in women: 

Shortness of breath - This is the most common one. If a woman, especially one without prior history of respiratory issues or shortness of breath, seems to be having trouble catching her breath and/or complains of such, pay very close attention. If she continues to feel winded after sitting or laying down, it’s probably time to call for help.

Feeling of impending doom - This can range from a sense of general unease to a full-blown panic attack. This one is extremely important, and is the symptom most commonly disregarded by doctors and hospital staff. If a woman tells you that she feels ‘not quite right,’ or like something terrible is about to happen, or that she’s about to die, LISTEN TO HER FFS. 

Nausea and “indigestion” - Also common. Heart attacks frequently present as a feeling of vague nausea or indigestion, but unlike typical heartburn, antacids and other OTC treatments will not alleviate the symptoms.

Hiccups - Unexplained hiccups, especially if seen with any of the other symptoms listed above, can be indicative of heart muscle that is being acutely or chronically starved of oxygen.  The exact mechanism isn’t known, but it’s thought that the enzymes released by the dying muscle irritate the pericardium and adjacent diaphragm, causing spasms in the healthy muscle. 

Fatigue - This is another commonly seen symptom, and is often overlooked or ignored as just transient tiredness. Many women having a heart attack will complain of feeling “flu-like” symptoms of nausea, sweating, fatigue, and shortness of breath, and they’ll lie down for a nap and never wake up. 

Lightheadedness - A feeling of being lightheaded or about to faint isn’t terribly uncommon in many benign conditions, and many women experience it on a monthly basis. However - be aware when it appears unexpectedly or unexplainedly, and/or with one or more of the other symptoms on this list. 

Sweating (diaphoresis) - Heart attack does funny things to the sympathetic nervous system, which is behind reflexes such as sweating and hiccups. If a lady is experiencing unexplained or excessive sweating, pay attention to anything else that might be going on with her. 

Tingling or numb extremities - A feeling of numbness or “pins and needles” tingling in the extremities can be an important sign that cardiac function is being impaired and those body parts aren’t receiving enough oxygen. 

Peripheral and/or central cyanosis - Often accompanies tingling or numbness, and is considered a later-stage symptom of cardiac distress and heart failure. Finger and toe tips will turn pale or blue first, and lips and gums after that. Important to remember that darker-skinned women may present cyanosis as ashen, grey, or darker purple rather than pale or blue. 

Back pain - Pain between the shoulder blades, in the cervical spine, or even further down in the torso or lumbar region can be a symptom of heart attack. Alone, it isn’t that suspicious, but if it’s unrelenting and presents with any of the other symptoms above, keep a watchful eye on things. 

Classic “crushing” or “tight” chest pain or pressure - Women DO experience this classic pain, too, just not as frequently as men do. This may be due to our higher pain threshold, or differences in blood volume, or maybe we’re just not sure because nobody’s bothered to really study it. Whatever the reason, some women do still experience the crushing or tightening pain, and others may experience less painful pressure or tightness that doesn’t seem to be relieved by anything.

Arm and jaw pain - Another “classic” heart attack symptom, and a bit more common than central chest pain. Unexplained pain in the left arm or shoulder, and on the left side of the neck or jaw, should not be ignored by anyone.

Your gut is almost always right

Had a patient post-pci who despite denying chest pain had ST elevation on the cardiac monitor. My charge dismissed my concerns. I got an EKG to confirm my suspicion. Sure enough when compared to the initial post-pci EKG there was significant elevation.


Again, I notified my charge. He dismissed my concerns & went so far as to tell me this is a common finding as they just irritated the cardiac muscle. This didn’t soothe my concerns as the initial EKG should have the same elevation.


Regardless, I call the physician & they take the patient back to cath lab. Patient had reoccluded the stent & was having another MI.


Trusting your gut is honestly the best advice I can give any nurse or any medical professional.

youtube

This is my first ever youtube video! An explanation of myocardial infarction for A Level. I’m proud of it, so I thought I’d share!

The ink cap mushroom. The black is a liquefaction of the gills. 

The black liquid that this mushroom releases after being picked was once used as ink.

The mushrooms are poisonous, though for the most part a bite is fine. They are not food mushrooms, and are not meant to be eaten long-term or in large amounts.

These mushrooms are also called Tippler’s Bane. People who drink before or anywhere from three hours to five days after eating an inky cap will find that they have a red face, tingling limbs, and a racing heart. Then nausea, vomiting, and in severe cases, heart problems. The more alcohol the person drinks, the more they’ll suffer.

This is “disulfiram syndrome” and it can cause myocardial infarction (heart attack) (though this being lethal is really quite rare.)

Inky, dripping mushrooms.

(Edited due to a couple of points being clarified by someone who lives in an environment where these commonly grow.)

Ereri/Riren Fanfiction Rec List (Updated!)

This is a huge list. Like wow. This took a while.  Anyway, these are all really amazing fanfics, and y’all should check them out.  As you may be able to tell, once I find an author I like, I tend to read everything they wrote. Also, I know that a lot of these are present on other rec lists, but that’s because they’re just that awesome so I had to include them. I know that lots of these are available on both AO3 and FFN, but I just linked them to whichever site I read it on first. This list will be updated as I find new fics, cause there are just so many wonderful fics and authors for this pairing. 

FFN

Completed Multichapter

These are all AU for some reason.  I did not intend for this to happen but whatever. Less tagging for me.

Freedom of the Press- kylar04- 196k- M

Soccer player!Levi and hemophiliac college student!Eren. It’s so cute, full of drama and angst and fluff and wonderfulness. 

Steered Straight- kylar04- 128k- M

Modern military AU. just amazing. And sad. And happy. And everything

Shattered Facade- kylar04- 45k- M

Abusive relationship AU.  Really sad but sweet.

Rebellious Nobodies- PrincessSmutButt- 122k- M

College AU. This one freaked me out a lot but I’m not really sure why, so I guess just nonspecific TW. Unexpected ending and lots of emotional pain.

Crash- ObdurateSinner- 201k- M

The one where they’re both pilots. One of the first ereri fanfics I read and one of my favs.  TW for plane crash.

Danger Line- lunatrancy- 117k- M

Police officer!Eren and Mafia boss!Levi.  Lots of action and angst. It’s wicked awesome.

The Wolf and the Bat- hidansbabe503- 119k- M

Vampire!Eren and werewolf!Levi.  LOADS of errors and weird confusing dialogue where the person’s reaction to a sentence is right next to the sentence so it looks like that character said the sentence but they didn’t.  You’ll see what I mean.  Very sweet college AU anyway.

A Forged Wedding- mistyhollowdrummer- 202k- M

Levi asks Eren to marry him for a month.  TW for referenced child abuse. Some words or sentences that don’t make sense but great story nonetheless.

Threads of a Fairytale- lunatrancy- 88k- M

Cursed prince!Levi and poor farm boy!Eren. All the fairy tails and its adorable.

Sugar on Top- lunatrancy- 123k- M

Sugar daddy AU.  Not as creepy as I thought, with a mildly confusing plot twist at the end.

Temporary Mistake, Permanent Fix- Chappy-the-Bunny- 149k- T

Tattoo shop AU.  Interesting characterization and great story.

Feathers and Follies- Chappy-the-Bunny- 185k- T

Really really cool take on reincarnation AU.  Angel!Eren is the best thing ever.

A World of Our Own- LittleGreenPuppy- 187k- T

Modern arranged marriage. SO CUTE.  A bit of angst but not overwhelming.


Incomplete Multichapter

Not including word count cause that’s gonna change. 

Glitter, Glamour, and Ties- LiveToLie- M

Stripper AU.  Not really what I was expecting but it’s great.

The Change You Wish to See- mistyhollowdrummer- T

Eren is deaf and Levi works at a bookstore. So much fluff.

Why The Fuck Not?- HolyShitIt’sSenpai- M

High school AU.  Levi’s a badboy and it’s funny.


AO3

Completed Multichapter

Louder Than Words- TheArtOfWar- 142k- AU- E

Okay I tried reading this a while ago and wasn’t into, but I tried again yesterday and holy shiitake mushrooms. Read it. Really graphic violence.

Monster- loveatfirstsight- 48k- AU- E

Mental institution AU. Not the most realistic portrayal of things but idrk. It’s interesting and well-written.

Come in with the Rain- itsaroosterteeththing- 41k- AU- M

Super ridiculously fluffy teachers AU and I just want to snuggle them but they’re not real *cries*

1994- Vee- 124k- AU- E

90′s AU and it’s so freaking good. 

The Talk- WhiteSilverandMercury- 109k- AU- E

Hands down best stripper!Eren AU I’ve read. Super well-written and the plot twist at the end will fuck you up real bad.

Stowaway- OneWhoSitsWithTurtles- 30k- AU- E

Pirate Captain Levi because what more could you possibly want.

10 Years- appleapple- 25k- Canon- E

Ten years after the war, Eren returns to find the world has moved on.

Hey Lover- wasterella- 228k- AU- NR

Eren is sick of being teased for not having a girlfriend, so he finds a site that gives the illusion that he has one. But Levi is not a girl, and this might be a problem. 

The Intern- Lutte- 399k- AU- E

High school (sorta) AU.  Check trigger warnings.  Much angst but so good.

Beyond The Walls- Light_Within_Darkness- 72k- Canon- E

Wilderness survival.  Jean is just awkwardly there.

The Red Long Johns, Or “Be Sure to Dress In Layers”- shulkie- 30k-AU-E

The one where they’re both teachers chaperoning a camping trip.  So fluffy.

Wanderlust- Sabrinanikkol- 109k- AU- E

Eren gets set up as Levi’s ‘travel buddy’.  They go to France.  Fun.

It’s Funny Because Eren Can’t Read- BlakeBrolovski- 109k- Canon- E

Eren can’t read. Second person POV omg it’s weird but cool.

Placing Faith- OneWhoSitsWithTurtles- 155k- Canon-ish- E

The one where 20 year old Levi adopts 8 year old Eren. So ridiculously sweet.

A Sound Like Breaking Glass- mongoose_bite- 53k- Canon-ish- E

Where they all live by the ocean and Eren longs to join Captain Levi’s ship. Right? Slightly confusing but cool once you figure it out.

Fireside- twisting_vine- 37k- AU- E

Modern Canada AU. The one where Levi’s car breaks down and he has to stay with friendly neighborhood farm boy!Eren. So fluffy.

Holding Hands In The Rain- twisting_vine- 101k- AU- E

More modern Canada AU. Absolutely beautiful and well written. One of my favorites.

Art of War- catsonfire- 53k- AU- E

Modern AU where Levi and Eren are neighbors and have fun screwing with each other.  Figuratively and literally. Cute oneshot epilogue:  Tying Loose Ends

am- loveatfirstsight- 101k- AU E

Great story. Trigger warnings for mental health issues and a boatload of angst.

Junkyard Dogs- acidtowns- 70k- AU- E

Prison AU. Honestly kind of disturbing but in the way that you can’t put it down. TW for violence, mental health issues and obviously, prison.

Haute Couture Love- SailorHeichou- 123k- AU- E

Fashion AU.  LOTS of grammatical errors and weird capitalization of random common nouns, but cute story anyway. 

Deal With It- Corporal_Levi_cleans_my_house- 138k- AU- E

Sweet Omegaverse, one of the only good MPreg fics I’ve ever read.

Neither Tarnished Nor Afraid- mongoose_bite- 73k- AU- E

Cop!Levi and Vigilante!Eren.  Really interesting.

Epilogues Are Always Better Than Prologues- ninanna- 37k- AU- T

Publishing company AU.  Where Eren and Levi dated before and somehow end up at the same company. 

Night Drive- shotgunsinlace- 50k- AU- E

Levi is married(?) to Erwin, but no one seems to care.  Plot twist.

Warm Water- KeroseneShowers- 35k- Canon- E

Levi’s shower breaks. Eren attempts to fix it. 

Grounded- appleapple- 22k- Canon- M

Eren gets grounded for a year when he gets drunk and destroys a bunch of stuff.  Cute.

Incomplete Multichap

Again, not including word count.

Sometimes Things Turn Out For The Best- Resmiranda- AU- E

Levi is Armin’s editor and lil mushroom plays matchmaker with his editor and his roommate. Really gud.

Just My Luck- SecretGhostGirl- AU- M

Levi is Mikasa’s boyfriend and Eren has a crush.

Ein Riese, der Fliegen Wollte- Closet_Cleaner- Canon-ish- E

Eren is not a human that can turn into a titan, but instead a titan that can turn into a human. Really interesting and well-written.

What’s Eating You?- TheSpazzBot- AU- M

I thought this was about vampires and I was *mostly* wrong. This fic is amazing.

Misread- sciencefictioness- AU- E 

Eren has depression and Levi is his boss and they’re both just trying to figure their lives out. Pretty realistic, I think.

The Strange and the Usual- lalazee- AU- E

Levi owns a halfway house for possession victims. Confusing but really good.

Red Heat- Sciencefictioness- AU- E

Probably the best Omegaverse AU I’ve read.  Lots of action and violence.

The Stag in the Dark- shulkie- AU- T

Knitting AU. I didn’t know a knitting AU was a thing but it is and it’s great.

Under The Bed- Corporal_Levi_cleans_my_house- AU- E

Demon!Eren.  There is a portal to Hell. Excellent. 

Shotgun Blues- Corporal_Levi_cleans_my_house- AU- M

Hitman!Levi and photojournalist!Eren.  Awesome. 

Everytime I Poop, I Think Of You- suckaknob- AU- M

Levi and Eren get drunk. And married.  Hilarious. 

Demons and Darkness- Sciencefictioness- AU- E

Demon AU. Obviously. Very interesting.  Violence.

One Shots

Okay I’m a little weird but I consider anything that’s completed with under 20k words a oneshot. So don’t be surprised if some of these have like 12 chapters. These are all on Ao3 by the way.  

Uber Attraction- MicellaneousShenanigans- 1k- AU- NR

“The Uber driver Eren one-shot you didn’t know you needed.”

Acute Myocardial Infarction- missmichellebelle- 14k- AU- G

Doctor! Levi and Eren is so adorable oml. 

Bon Anniversaire, Mon Cheri- Opulence- 8k- Canon- T

*cries*

Be Good for Me- TheSpazzBot- 15k- AU- E

This is just PWP but its really good PWP.

No-Smoke, No-Gamble-  PresquePommes- 9k- AU- M

Eren is fob from Germany and his inability to English is kawaii as fuck.

Don’t worry I’m weak to you- myoue- 6k- AU- E

Delivery boy!Eren gets stuck in Levi’s apartment during a storm.

Heart of Ink- OnewhoSitsWIthTurtles- 15k- AU- E

Because we all need another tattoo parlor AU, right? 

My Home Is Where Your Heart Is- bfketh- 14k- AU- E

Levi is needs a babysitter for his daughter Mikasa and Eren seems like the right guy for the job. Adorable.

beyond the sea- TheSpazzBott- 12k- AU- E

Merman AU. Really cute. 

Last Customer- mongoose_bite- 5k- Canon- E

After the war,  Levi owns a coffee shop. Such fluff.

Don’t Speak Against the Sun- appleapple- 18k- Canon- M

Erwin thinks Levi and Eren are spending too much time together.  Such a beautiful story. 

Strike Twice- shulkie- 9k- AU- T

At Mikasa’s wedding Eren is tasked with keeping Levi there until cake. Funny and cute.

Hit or Miss- Monsoon- 4k- AU- M

Levi is an assassin who just broke his cardinal rule.  Funny.

Trump-l’œil- appleapple- 11k- Canon- M

He has never minded the bitterness at the bottom of the cup. Wonderful.

meeting people is easy- foreverautumn- 4k- AU- NR

Super sweet and funny. Read it twice and it’s even funnier.

Give The Dog a Bone®- TheSpazzBot- 16k

Hilarious modern AU where Levi’s dog likes Eren a little too much.

The World Has It’s Shine- catsonfire- 7k- AU- T

Another coffee shop AU. There can never be too many.

Grind- TheSpazzBot- 14k- AU- M

Levi owns a tea shop and Eren owns a coffee shop. They become arch nemeses. Funny modern AU.

Bemused!- mongoose_bite- 8k- AU- T

Really interesting idea and super cute story.

Of Mistletoe and Shitty Fake Boyfriends- TheSpazzBot- 13k- AU- T

The one where they pretend to be dating. 

Blackbird- inkshaming- 9k- Canon- NR

After the war. Absolutely beautiful story.

Christmas at the Ackermans- zhedang- 8k- AU- T

Levi is Mikasa’s cousin and Eren has to pick him up at the airport. Sweet and festive.

Unexpected death

Today was my first shift on an ICU, it was terrifying and exciting at once. The only patient I will continue to think about even though my shift is over, was someone who wasn’t chronicly ill and expecting to die. I have worked with mainly medical patients, patients who have had an illness for years and sooner or later, it gets so advanced they know they have little time left. Todays patient had a myocardial infarction on the street, on holiday here with his wife. He was fully sedated and intubated, he was no longer breathing himself. Later his pupils were blown, fully dialted, and doctors suspected brain stem death. There was nothing that could be done. His hands were freezing cold as he began to peripherally shut down, his son desparately trying to get down from Scotland before official death. I will never forget the image of his wife crouched over at his bedside, holding onto his hands, his arms, him. The man she woke up next to on their holiday and planned to visit the town with. The man she has now accepted she will not be going back to bed with tonight. She will be packing his things and going back to Scotland without him. It kills me.

anonymous asked:

Can you have a heart attack while in a coma? What would be some of the reasons for that?

Hey there nonny! Heart attacks and comas are not mutually exclusive, so yes, your comatose character can have a heart attack on top of whatever troubles made them comatose. 

Heart attacks in the medical definition (myocardial infarctions) happen because the character has some plaque build up in one of the arteries that feeds the heart (the coronary arteries) that then completely occludes, starving the character of blood in that part of the heart. This can occur without the character being awake. 

Unfortunately, because the character is unconscious, they won’t be able to report the chest pain or shortness of  breath – they’ll likely be intubated – and so it will take doctors a while to figure out what’s going on. An EKG takes a while to show an MI, especially if the MI doesn’t affect the EKG leads that show up on a monitor. (Basically, damage to the inferior wall of the heart is what shows up in leads II and III, the typical “monitoring leads.” Damage to other areas won’t be so obvious.) 

They may not even realize the character is having an MI until the patient craps out completely and dies from their infarct. 

There are other, more connected events that might kill a character in a coma. One is a worsening of whatever caused the coma – usually a brain injury of some sort. Another is a pulmonary embolism. Bodies don’t like to be totally still; they’ll form clots in the deep veins of the leg (Deep Vein Thrombosis, or DVT). That DVT can break off and go to the lungs, and block the blood vessels that feed the lung, called a PE (pulmonary embolism). This is a very common cause of death in patients admitted to the hospital and especially in the ICU. 

Hope this helped!! 

xoxo, Aunt Scripty

(Samantha Keel)

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New & Improved FreeBook: 10 BS “Medical” Tropes that Need to Die TODAY!

  • Charlotte: If anything goes wrong, fake a heart attack.
  • Lizzie: What are we thinking? The classic Angina of something sexier, like a Myocardial Infarction?
  • Charlotte: Just drop to the ground and wiggle.