Some of the most important diagnoses in pre-hospital care are the ones we least expect, conditions that challenge our assumptions, present outside familiar clinical patterns, and can be missed when we rely too heavily on traditional assessment tools.
In this episode, we revisit two important conversations from the Pre-Hospital Care Podcast that highlight the consequences of diagnostic overshadowing and the need for clinical curiosity.
First: Spontaneous Coronary Artery Dissection (SCAD)
SCAD is an important, often under-recognised cause of acute coronary syndrome. It can affect patients, particularly women, who may have few or none of the traditional cardiovascular risk factors associated with myocardial infarction. Through the perspectives of a survivor, the clinician who treated her, and an advocate raising awareness, we explore how SCAD presents, why it can be overlooked, and how pre-hospital clinicians can improve recognition.
🎧 Listen to the original episode: Spontaneous Coronary Artery Dissection (SCAD): The Condition We Often Miss
Second: Posterior Circulation Stroke
FAST has an important role in stroke recognition, but it does not identify every presentation. Posterior circulation strokes can manifest through dizziness, imbalance, visual disturbance, impaired coordination, and difficulty walking, sometimes without the classic signs of facial weakness, arm weakness or speech disturbance.
Joining us in the original conversation, paramedic and researcher Shane Devlin explores the clinical and research challenges of recognising posterior circulation stroke. My brother, Ronan Walker, also shares his experience of suffering a posterior stroke in his late thirties, highlighting what can happen when symptoms don't fit the expected picture.
🎧 Listen to the original episode: Not So FAST: Rethinking Stroke Recognition in Pre-Hospital Care with Shane Devlin and Ronan Walker
The key message: The patient doesn't have to fit the textbook for the diagnosis to be real. Whether we're assessing a potentially life-threatening cardiac event or a stroke that falls outside traditional screening criteria, careful assessment, clinical curiosity, and a willingness to challenge our initial impression can make a critical difference.
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