Throwing a pathetic pseudo-seizure on the floor of the ER in front of the Nursing Station is not going to get you Dilaudid any faster than faking back pain.
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.
Too all ER doctors out there I give you this advice:
If you have a patient that is sick and a consultant over the phone tells you a specific way to manage it that you think is completely wrong, don’t just do what they say. Especially when it is out of their field of expertise.
I had a patient nearly die because a certain private MD refused to let me perform an intervention that I thought was entirely indicated. I held out because the patient was stable at the time and I didn’t want to create an argument.
Sure enough, several hours later,while the patient was languishing in the ER waiting for a bed he coded and almost died.
I’m still beating myself up over this poor decision.
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!!
