Who Best At Your Side During Major Heart Attack?

[George Rice]

1. Paramedic - This is what he's trained for. None of the others will have the hands-on experience he does with this situation. And he's usually in contact with a physician.

2. Emergency room specialist - He will have some experience with heart attacks, but not nearly as much as the paramedic. Most heart attacks don't happen in the emergency room. Although his skills dealing with the aftermath will be important.

3. Intern - Probably had some recent emergency room training and will have some experience with the latest equipment.

4. Cardiologist - Hearts are his field, but he probably hasn't had to deal with many emergencies lately and his skills in this area may be rusty.

5. Anesthesiologist - Huh? Am I missing something here? I'm not sure about the issues that must be addressed in a heart attack, but administering oxygen is one of them, a very important one of them. But the others should be able to do that adequately. I don't know of any skills he would specialize in that would matter that much. If there are, it might move him above the Cardiologist.

[Matt Flynn]

Fifth is internist unless just recently out of residency.

Fourth is paramedic. Always better to have someone for whom it's routine and who will not panic.

Since you gave all usual equipment as a condition, hands-down first would be an interventional cardiologist. Get your heart into the cath/monitoring lab immediately. If you must have a heart attack, that's where you want to have it. Once you get beyond aspirin, oxygen, defibrillation, meds, and intubation and get to TPA, stents, unusual rhythms, and so forth, they're the pros.

Since you said any cardiologist, it's not as clear.

Second and third depends on the doc. I think part of the issue is many people may not know what anesthesiologists do. For example, a lot of them run ICUs. They are the best at intubation and placing lines, which can be the hard part of a code.


What you should do: call 911, have the person chew an aspirin or Goody's or BC powder (Tylenol and Advil are useless), sit them down on the floor (harder to hurt yourself if you don't fall far when you pass out), get an automated defibrillator if you have one and place the leads immediately (the machine decides what to do from there), don't panic, and figure out who will do CPR -- the calmest-looking person who knows how is a good choice.

[David Sklansky]

Anesthesiologist, especially if the heart stopped. Don't ask me why.

[JacKnight21]

Different definitions

2/3 of heart attacks are "minor" i.e. damage to the heart is non fatal these people benefit from MONA (morphine oxygen nitro(some debate) aspirin(probably most beneficial))& beta blockers. Who ever gives these the fastest would be the best probably the paramedic the doctors probably would be examining for other things and looking for someone to order around.

1/3 of people don't survive 1 hour these people have "major" heart damage or arrhythmia they need greater interventions to survive: cardioversion (quickest to the paddles is best) antithrombolytic drugs to break down the clot down or heart catheterization (balloons or stents)to open the vessels. These drugs can be given by cardiologist, ER and studies have had paramedics give them. Interventional cardiologists are the only ones who perform the interventional heart procedures. All these procedures are with significant risk complications and contraindications.

other procedures balloon pump, pacing, cardioversion heart surgery

Any individual who is properly trained and equipped would work but there are some innate strengths assuming all are top in their field(big assumption) remember 1/2 of all doctors are below average while 95% think they are above average just like poker players.

Paramedic-Could be trained to perform all activities except interventional catheterization

Cardiologist-Heart expert but may have problems with difficult IV access or airway management

Internist offers no significant advantages over a cardiologist since they are internists with greater training, but that being said a recent grad may be very good.

Anesthesiologist-iv access expert airway expert familiar with cardiovascular drugs monitoring and many procedures

ER- expert at the first hour of care

[RJT]

[ QUOTE ]
Anesthesiologist, especially if the heart stopped. Don't ask me why.

[/ QUOTE ]

Wow,the exact person I would think least likely to help in this emergency. In fact, I was typing out a response to George Rice saying I wondered like he did when he said “huh?”

Ok, medical folk let’s hear what you know. Why would we want an Anesthesiologist.

[Big TR]

I believe that the Anesthesiologist knows so much about which drugs keep the body going in a shut-down scenario that they are the winner.

[Matt Flynn]

[ QUOTE ]
[ QUOTE ]
Anesthesiologist, especially if the heart stopped. Don't ask me why.

[/ QUOTE ]

Wow,the exact person I would think least likely to help in this emergency. In fact, I was typing out a response to George Rice saying I wondered like he did when he said “huh?”

Ok, medical folk let’s hear what you know. Why would we want an Anesthesiologist.

[/ QUOTE ]


I'd take anesthesiologist if interventional cardiologist isn't separated out.

Of the five, an anesthesiologist will likely have the most recent experience, knows the meds cold, and can get access to veins and lungs better than anyone else. Tough to say vs. an ED doc who does a lot of heart attacks. If ED doc is doing that every night, we like him too. But overall, a random anesthesiologist is probably the best bet.

[Mickey Brausch]

[ QUOTE ]
Who Best At Your Side During Major Heart Attack?

Assuming they all have complete access to all equipment and are equally skilled in their field.



[/ QUOTE ] This time it's gotta be the UFC guy.

[Aukai]

As a med student who's rotated through all of these, anesthesiologist is unquestionably the right answer.

What matters during a code? Airway and IV access. Nobody intubates (sticks the tube down the windpipe) better than the anesthesiologist, who does it routinely many times a day. This is especially true if the patient is obese or otherwise has a difficult airway. ER docs are probably next best at it, followed (maybe equalled by) the paramedics. Internists including cardiologists don't intubate or manage airways as often, so they come in last.

Next you need IV access to push your drugs. Anesthesiologists start their own lines routinely. ER docs not so much, it's usually the nurses that start ER lines. Medics are good at it for sure. Again, the internists come in last here- they just don't start IVs very often. Again, if the patient is obese, has bad veins, or is otherwise a hard stick, the anesthesiologist who you want to be there.

Also important- knowing the procedures to run through, which means knowing ACLS. Anesthesiologists will know the algorithms and the drugs cold. ER docs and internists will be behind them since they do run codes but less often, and the medics come in last (though not by much) because of their incomplete knowledge of why the algorithms are what they are.

So at the end of the day:

1)Anesthesiologist
2)Emergency Doc
3)Paramedic
4)Cardiologist
5)Internist