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I wanna see The Pitt version of this and it's just Ogilvie getting chewed out.

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I learned today in class that a sign of low calcium (hypocalcemia) is anxiety, so next time I'm having a panic attack I'm just going to eat some string cheese and hope for the best

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Demand Ischemia

So a patient comes in with a chief complaint of chest pain and we see widespread depressions, but no elevations. The patient is pale and diaphoretic, his pulse is high, and his oxygen saturation is low. Our immediate thought is a pulmonary embolism causing heart strain. We order the Angiography scan which requires me to check the kidney function before administering contrast, and we get this unexpected result on our bedside lab machine

Never have I had a hemoglobin so low it didn’t show on the iStat. I went up to the provider and let her know. We redid it with the same result. Lab called and told me they received a suspiciously low hemoglobin and wanted to make sure I didn’t dilute the sample before informing me the hemoglobin was 3.5. They also informed me that the Troponin was positive.

Because of his clinical condition and deteriorating cardiac status, this patient received 2 units of red blood cells on a rapid infuser in the emergency department and was transferred to ICU with a diagnosis of GI bleeding.

Demand ischemia occurs when the energy demand of the heart exceeds its energy supply. Usually this is seen in patients with extremely high heart rates, but it is also possible to see the same when oxygen supply is very low from conditions such as hypoxia and anemia, as demonstrated in this case.