Jul 16, 2024
What do ya do in healthcare?
mostly suffer
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What do ya do in healthcare?
mostly suffer
Patient presented to ER after being awoken from his nap with chest pain. He called 911, and he was STEMI alerted. 20 minutes later, our EKG showed he was already tomb-stoning. Get assigned a cath lab bed but are told “hang on, we aren’t ready.”
30 minutes go by: they still aren’t ready. The patient turns to me and says “we can’t wait any longer. It’s getting worse.”
I say “what do you mean?”
and he says the words none of us like to hear.
“I’m gonna die.”
...
fast forward 10 minutes and he goes into his first arrest. We immediately shock him out of V-fib and he wakes up and says “what happened?”
“You passed out for a second, buddy. Don’t worry, you’re alive. We’re taking good care of you.”
We talk to our manager who calls cath lab. They say they still aren’t ready.
Second arrest. The first shock didn’t work and we had to do a round of CPR. Charged it up to full blast and hit him again and he came out of it. He’s groggy. He knows what’s going on and he repeats himself.
“I’m gonna die.”
Our director calls and tells the cath lab that the patient is coming, because at the very least, its better to wait in the cath lab room than in the ER.
We get him up. and as we get into the elevator to get back to the ER we hear them page a code to cath lab 4.
I don’t know what happened to him, but I think I’d rather keep it that way.
When you show up to CVICU to pick up your next patient for a Cardiac Cath and possible valvuloplasty and she has new onset left arm weakness when she tries to sign the consent...ummmm
We called a stroke alert and she went CT and then to IVR.😱
when you’re sitting at the circulator desk just charting away and you hear instruments start clattering and a raised voice
Work selfie..lol. nothing like a bi-v pacemaker on a Friday night
I work in the Emergency Department (see username). We have a TON of chest pain patients on a daily basis. 99% of them have nothing cardiac going on. A large majority of them come in gripping their chest, are anxious, and generally say something like “I’m having a lot of chest pain.”
I was passing by triage a few days ago and this one lady comes up and looks at the nurse and says very calmly and hesitantly, “I... think I’m having a heart attack.” You can see the fear on her face.
The triage nurse, un-phased, asks “What makes you think that?”
she says “I don’t feel right. I’m tired, and I feel like there’s a hole going through the center of my chest. I feel like I’m going to die, but I don’t know why.”
Red flag.
We bring her to get an EKG and shes having a massive heart attack. ST elevation was nearing tombstone morphology in the anterior leads. (pictured above is not the actual EKG, but is similar.)
IMPENDING DOOM is a VERY IMPORTANT clinical sign. Unfortunately, our view can be skewed from all of the drama kings and queens who walk in the ED every day, so we need to make a conscious effort to observe for this sign and act urgently, even in absence of other clinical signs.
Got called in for a STEMI. Dayum! Look at them ST's!!???? This is a 68 y/o male with CAD and previous CABG x 4. Graft to the RCA was down, although we stented it, we had no re-flow. Pt was 'shocky' so we place an Impella to help lighten the load on his heart. His pressures improved greatly. He also needed a temporary pacemaker inserted because he kept dropping his HR into the 30s. Unfortunately, he may need surgery again to fix the closed graft.
I went into work on my day off to help in the Cath Lab today, what a damn train wreck!
My first patient ended up in complete heart block and needed a temporary pacemaker while we were trying to measure Rt Heart pressures for Aortic Stenosis. Wtf.
My second patient was an 83 y/o MI from the ED who’s O2 Sat’s were shit from the start. Doc didn’t want to intubate “she’s fine” he said🙄, we took only 5 pics and she ended up in flash Pulmonary Edema. She freaking quit breathing on the way to CVICU. She had to be intubated as soon as we got into the unit. Thank goodness for intensivists!!
My third patient had a allergic reaction to the contrast and needed to be admitted. Thank goodness she ended up being ok. Fuck
Geez, I think I should have just stayed home.