Is it just me or does bombing suspect Dzhokhar Tsarnaev look like Noel Redding from the Are You Experienced album from the Jimi Hendrix Experience?
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- no. only the eyebrows.
Surprising Encounters Archive
Separated at birth?
By Dr Killpatient | Filed in Surprising EncountersIf you ask me, the most important thing you need to be able to do when working in the ER as a doctor or a nurse (and to only a slightly lesser extent, as a tech or a respiratory therapist), is to be able to recognize when someone is in cardiac arrest.
Sounds pretty basic, right? Then how can some people who should know better (ie BLS/ACLS trained) not realise that a pt who becomes unresponsive is in fact pulseless and apnoeic!
Come on people, feel for a pulse and check for respirations!
- Apnoeic is "not breathing". I always get called for the patient who's short of breath, but won't hang up the ...
- FTW
- Well, I would, but they need to learn to show me their insurance card first.
Ok, I know I’m not posting as much but I need to wait for something to inspire (or infuriate) me. Here is a case that did:
78 y/o male with HTN and High Cholesterol but no other known cardiac disease presents with generalised weakness over about a 1 hour period. His family said he just said he did not feel well and went to lie down on the sofa. He soon was found to be semi-responsive so they called 911. Medics found him with AMS but rousable and a HR of 140 and an SBP of 90. Fingerstick normal
In the ED his vitals and appearance were very similar. He would rouse and described some vague abdominal discomfort but was more or less semi-conscious. He had a temp of 100.8, was tachy and hypotensive. Lungs clear abdomen mildly distended and slightly tender. Skin pale. EKG showed rapid Afib (pt had no prior history).
CXR normal, WBC 20K, lactate 5.8, Cr 2.0
What is it? I’ll tell you what I thought it was (and what I did for him) and what it turned out to be in the answers.
- Why not do a quick US? See the AAA, you got your diagnosis.
- Ok. The answer. I figured it was dead bowel from mesenteric ischemia given the new onset afib. I fluid resuscitated ...
- Ruptured AAA diagnosed via US, resuscitate with blood products, to OR.
Vtach>syncope>see me>Amiodarone 150mg>syncope>cardioversion>Vfib>
CPR>Defibrillate>Amiodarone>NSR>
wakeup>IWMI>Vtach>syncope>cardioversion>
Vfib>CPR>Epi>NSR>Wakeup>
Vtach>Lidicaine>Cardiovert>Vfib>CPR>
Defibrillate>Epi>NSR>Wakeup>Goes to CATH lab.
Whew!!
- Yay for you all. What a team effort to stabilize and you did it.