Saturday, August 08, 2009

Finally – Summer

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.


TOTWTYTR said...

I'm amazed that the NH had a 12 lead machine. I'm NOT surprised that they misread the strip.

Walt Trachim said...

Actually, I thought they were wrong about the V-Tach. My initial reaction (to myself) when the charge nurse told me about was, "no way! you're full of crap!" because nursing homes usually are about that sort of thing, as a rule... However, when I looked at their 12-lead from about 20 minutes before we got there, it turned out that they were right. It's just that it had "resolved" for lack of a better word before we got there. But it was still a gnarly looking bit of rhythm. I got a 12-lead on my LP-12 immediately, and while it didn't look like theirs, it was nasty enough that I didn't really want to stick around. ST elevation in the inferior leads with reciprocal changes, and lots and lots of PVC's.

It looked like an IW-STEMI to me. But because of how sick he was and the amount his extremities were used up, we didn't really have much to work with.

It sucked.

Karen Brook Westhaver said...

Oh the poor guy...the 86 y.o. cardiac pt. While it was tough for you guys, I'm glad you were the ones who had the call. I know he got compassion and clearly the best of care. You've had a really busy time of it! I hope you managed to grab some time here and there to enjoy the at long last, summer day. And I REALLY hope things ease up for a while!

Susie Hemingway said...

It must be tough to be your shift, when the day turns out to be the kinda of warm and sunny day you would love to take advantage of. How pleasing to know that it was You that turned up to help the elderly man with kindness and compassion, when he was frightened and so poorly. Great to know good Guys still exsist in this not always so kind world.