Question

SCENARIO: GP CLINIC

An Indigenous grandmother is brought into the GP clinic by her granddaughter after the grandmother started having stomach pain whilst gardening with her granddaughter. The granddaughter has dirt on her face and hands and her shirt is grubby. She is very anxious and worried about her grandmother and asks questions about every intervention that is done including vital signs, oxygen therapy, ECG etc.

She is very concerned about her grandmother’s pain and asks for pain medication. She asks questions like: “Can’t you do something for her pain?”, “Why are you taking blood from her?”, “When will the blood test be back?”, “What are you looking for on this machine?”, “Why is she sweating so much?”, “Is she bad?”. When you give her Grandmother Nitroglycerin, she asks; “What are you putting under her tongue?” and “What does it do?”.

A) How will you ensure a culturally safe environment in this situation?

Answer 1

Answer :

As this patient is old age and presented with symptom such as abdominal pain and excessive sweating when done some work in garden. This may be a case of acute myocardial infraction. Typically cardiac pain is occur in the left chest region. But in some cases cardiac disease can present atypically like abdominal pain, left arm pain, shoulder pain, jaw pain etc. High index of suspicion is necessary for immediate diagnosis of these danferous condition.

Investigation:

If we suspected this as a case of MI, immediately we can do an ECG to look for any ischemic changes like ST segment elevation in needs. Some time ECG changes also take time to develop. Otherway like blood test for cardiac enzymes mainly troponin also useful. It take one hour for the report to get. This enzyme will increase mainly if any ischemic changes occured to the myocardium, as occured in myocardial infraction.

Other method like echo cardiography also useful to find out any ventricular or valvular problems. As this condition posses immediate threat to life, because if any region of heart get damaged, there will be less efficient pumbing of blood to the peripheral organs and results in tissue damages. So we have to act fastly to give supportive meassures.

Emergency medicine :

As a emergency meassure, we can give sublingual nytroglycerine medicine. This medication causes vasodialation, mainly the coronary arteries which supply blood to heart. So if any obstruction to the blood flow present in these arteries, it will be relieved. So it will improve oxygen supply to myocardium. Subligual route preffered because, it will be absorbed fastlythrough the veins under the tongue and reaches the heart very fastly. So it will improve oxygen supply to myocardium.

Pain :

The pain in MI due to ischemic to the nerve supplying myocardium. So immediate improving the circulation of blood flow to the heart will reduces pain and we can use morphine injection also for reducing pain. Other medications like aspirin, atorvastatin can be given. These will prevent further clot formation and dissolves already formed clots, that improve blood flow.

Appropriate management :

And as for as possible try to do angiogram and find out the blocked vessel and do appropriate management. ICU admission and monitoring vitals are necessary. After the correction of primary problem patient should be under bed rest. Avoidance of stress, strict regular medication.

And treat underlying comorbidities like hypertension, diabetes, dislipidemia.