Queen if central access, that is. Finally some excitement on cardiology. A very, very sick patient with an acute inferior mycardial infarction (heart attack). Symptoms included nausea and belching. EKG with ST elevations in II, III, avF. BP 80s over 50s. EKG went from sinus to V-tach right in front of us. The patient started moaning. His face turned a dusky blue. The ED attending was nearby and started shouting orders faster than I could form the words to say what I was thinking. “Open the code cart, 100mg of lidocaine. Let’s tube him now.” I started to get the intubation supplies and our ED intern asked if he could do the intubation. No problem. I set up his equipment and “supervised” his intubation. I gave him a little extra paralytic when the myoclonus from the etomidate overtook the partial paralysis he’d gotten with the first dose of succs that probably wasn’t big enough.
He then went straight to the cath lab, had an artery in his heart openened up, then came to the CCU, still intubated, on dopamine, with a transvenous pacer and an aortic balloon pump. I put in a left subclavian and floated a swan. We got an echo that showed his right ventricle was paralyzed. He was sick, sick, sick!
It was exciting, required fast thinking, lots of procedures and satisfaction of seeing someone who by all rights would have been dead hang on with the aid of some modern technology and cardiac medicines. Before I had left, he was actually doing better, with higher blood pressures and needing less dopamine. I assisted in the ED resuscitation, put in the central line, floated the swan, interpreted the numbers, coached the intern on now manage him overnight PLUS did three admissions for teh cross cover services I was on.
I was on my game tonight, and now I’m watching the Pittsburgh Steelers lose their game. Why do I take football so personally? Why am I more dissapointed that Tommy Gun isn’t the savior we all thought he was than I am about a dying man in the cardiac care unit?