history of myocardial infarction
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Case Study
Chapter 29
Issues with Rural, Migrant, and Urban Health Care
Marty, a 75-year-old male, with a history of myocardial infarction called home
complaining of heartburn and running out of antacids. When his daughter-in-law
reminded him to maintain his rest and diet times, Marty grew angry. “Knock it off. I
am doing fine despite what the doctor said. I will care for the diabetes after the
harvest and I will come home as soon as I can.”
Driving his combine formation with other workers for a night harvest, Marty
paused at 9:45 PM for a break while the rest of the combine formation continued
moving forward. Marty’s 6-year-old grandson rode in the combine with him to
experience his first night harvest. No further communication was received from
Marty’s combine.
The boy’s mother called again at 10:00 PM with no answer. Used to “farm
time” and dead space for the cell phones, she was not overly worried but was
concerned about her son being out so late at night. The mother called her spouse
who drove another combine in a different field to find out why the boy was not yet
home. The father dispatched a truck to find Marty while the combines continued
harvesting and gleaning.
The truck driver found the missing combine on its side in a gully with the
lights shining upward. A satellite phone was used to notify the Northern Air
Ambulance and the local 911 of GPS coordinates. The volunteer flight and
paramedic teams were dispatched. The Italian-made Agusta Power-109 helicopter
used instruments to fly over two counties of hilly terrain. The single pilot employed
night vision goggles to study the instrument panel and the radio to keep the pilot
informed of ground rescue operations and hospital preparations. The flight nurses
double checked the laryngoscopes, blood supplies, and jump kits while maintaining
contact with the first scene arrivals.
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When the paramedic vehicle arrived, an employee truck was seen driving
away from the combine. Marty was unconscious with a weak, irregular pulse of 100,
BP of 65/48, and respirations of 26. A bruise over the right mastoid is noticed. The
grandson is conscious and crying, splinted for a broken leg. His pulse is 120, BP
138/118, and respirations of 24. Purple circles are seen around his eyes. The 6-
year-old complains of a headache and calls for his mother.
1. How will the nurse gather needed information to effect a successful rescue?
2. What travel and emergency transport resources are available?
3. What rural barriers to diagnosis, treatment, and follow-up resources exist?
4. What roles do rural nursing theory principles play in Marty’s health
behaviors?
5. The nearest critical access hospital does not have a trauma level due to the
lack of a 24-hour staff with trauma training. What types of trauma support
do patient needs indicate?
