Well now. We finally have some summer-like weather up here. It is absolutely beautiful outside. Temperatures right around 80 degrees F, sunny, and dry. Absolutely beautiful outside. Perfect weather.
Now if only I weren’t working…
Thursday and yesterday ended up being a really long day. By the time the shift was over, we’d handled 3 vented patients (I talked about them to a degree in the previous post) and a number of other situations, including an 86 year-old male with a significant cardiac history coming out of My Favorite Nursing Home with chest pain. He’d been a patient at the BI during the week to be treated for what was presumed to be a STEMI. From what I understand, he refused all treatment while he was there. Plus he has a DNR/DNI order in place. However, 12 hours after he was discharged back to the nursing home the staff wanted him transported back to the hospital as his symptoms never really were resolved, and he was having runs of Ventricular Tachycardia during the night. So when we got there, we found this little old man in a puddle of diaphoresis experiencing 7-8/10 chest pain. He was indeed tachycardic (not in V-Tach, but showing what looked like significant right-sided enlargement on a 12-lead due to the size of the complexes in the first 4 chest leads) and he had a really soft blood pressure. He’d had 3 of his own Nitroglycerin tabs before we arrived, and with a systolic pressure of just over 100, he wasn’t going to get more. What he really needed was a fluid challenge to both help with his volume and challenge his right heart, but he was incredibly bruised and battered from his hospital stay; our attempts to get a line started were pretty futile. And I did something I almost never do: I actually radioed ahead, mainly because I was concerned that he might crash on the way.
It was a good thing I did that; we had a team waiting for us when we walked through the doors.
And today: it has been a continuation of Thursday. the patients have either been sick, large, or both, and I’m really hoping the trend doesn’t continue. It’s getting a little bit tiring.