Passenger with chest pain on a mountain pass
You are driving a colleague from Thaba-Tseka toward Maseru on a mountain pass. About 40 minutes into the journey your passenger, a 52-year-old man, says he has crushing central chest pain that started 15 minutes ago. He is pale, sweating, and short of breath. He has no known heart history and no medication with him. You are on a stretch with no lay-by, a steep drop on one side, and the nearest town with a clinic is about 25 minutes ahead; the last village is 10 minutes behind. It is mid-afternoon, the road is clear, and you have a phone signal.
1. What is the correct sequence of actions, and why is driving him yourself not the first choice?
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- Stop in a safe place as soon as one exists - do not continue driving while managing a casualty; a driver distracted by a sick passenger on a mountain road is a second emergency. If no lay-by, find the widest, flattest verge and stop clear of the traffic lane.
- Call emergency help / the clinic and state the location, the symptoms (crushing central chest pain, sweating, breathlessness, onset time), and that you are on the pass. Ask for guidance on whether to wait or drive.
- Keep him still and calm, sitting up (usually most comfortable), loosen tight clothing, do not let him walk about.
- Be ready to start CPR if he becomes unresponsive and stops breathing normally - and know where the nearest AED might be (clinic ahead).
Driving him yourself is not first choice because a casualty can deteriorate en route, and you cannot both drive a mountain pass and monitor/CPR a passenger. But if instructed, or if help cannot reach you, driving to the clinic is reasonable - with someone else monitoring him if possible.
2. He asks for water and wants to lie flat. How do you respond, and why?
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Lying flat: generally not advised for a conscious breathless casualty - it makes breathing harder and can worsen distress. Keep him sitting up, supported, which is usually the position of comfort for chest pain and breathlessness.
Water: a small sip may be allowed if he is fully conscious and not vomiting, but do not give food or drink if there is any chance he may become drowsy or need intervention - an unconscious casualty with a full stomach risks aspiration. Do not give any medication (including aspirin) unless you are trained and it is not contraindicated; the safe answer in a test context is to not administer drugs and let the clinician decide. The priority is rest, reassurance, monitoring of breathing and responsiveness, and rapid access to help.
3. What specific things do you monitor, and what triggers you to begin CPR?
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Monitor: responsiveness (talk to him, squeeze his hand), breathing (rate, effort, whether it is normal or agonal gasping), colour, and the pain (does it spread to arm/jaw, worsen?). Note the time symptoms began for the clinician.
Begin CPR when he is unresponsive and not breathing normally - agonal gasps are not normal breathing and CPR should start. Send someone to get help/AED if available; if alone, call first on a phone (you have signal) then start compressions. Continue until he breathes normally, help arrives, or you are physically unable to continue. Do not stop CPR to move him unless he is in immediate danger.