Great case at St.D's!
The PA brought back this EKG on a guy who had come in with abdominal pain, probably mid to late sixties. Because it was abdominal pain he was a lower priority EKG and it had taken an hour to get it. Son of a gun, but he had tall broad ST segments in the inferior leads and reciprocal changed in V1 and V2. Acute inferior MI! I put in for Cath lab and as I'm waiting to hear from them this woman calls out "Help--there's something wrong with my husband!"
I run over. New patient. Laying in the gurney, eyes open, teth bared, clenched hands held up towards his neck and a stricken look on his purpling face. Monitor? Coarse V-fib! Holy shit--he must have just dropped out! I yell "Code in C!" and I go for the pre-cordial thump. I haul back and punch the guy as hard as I can. In the text books they have images of a very dignified fellow in a white coat thumping his palm on the patient's chest, but I can't believe that technique gets any sort of discharge so I go with a clenched fist hammered into the sternum. Except I missed and punched this poor guy right in his gut. Shit, I reloaded and fired again and this time nailed him right on target--2 centimeters bove the Xiphoid process, mid sternum.
The team arrives, the wife flees the room, and I yell "Paddles first! Paddles first!" I start doing CPR. Our top gun nurse is on and we are a smooth team. The pads go on the chest and we defibrilate. Nothing. More CPR while the machine charges and we fire again. Got him--QRS's on the monitor and in seconds he's awake and fighting us. Minutes later he's relxed and I'm chatting with the family. Then off to cath lab.
Good, good, God damn Emergency Medicine!
U-561
The PA brought back this EKG on a guy who had come in with abdominal pain, probably mid to late sixties. Because it was abdominal pain he was a lower priority EKG and it had taken an hour to get it. Son of a gun, but he had tall broad ST segments in the inferior leads and reciprocal changed in V1 and V2. Acute inferior MI! I put in for Cath lab and as I'm waiting to hear from them this woman calls out "Help--there's something wrong with my husband!"
I run over. New patient. Laying in the gurney, eyes open, teth bared, clenched hands held up towards his neck and a stricken look on his purpling face. Monitor? Coarse V-fib! Holy shit--he must have just dropped out! I yell "Code in C!" and I go for the pre-cordial thump. I haul back and punch the guy as hard as I can. In the text books they have images of a very dignified fellow in a white coat thumping his palm on the patient's chest, but I can't believe that technique gets any sort of discharge so I go with a clenched fist hammered into the sternum. Except I missed and punched this poor guy right in his gut. Shit, I reloaded and fired again and this time nailed him right on target--2 centimeters bove the Xiphoid process, mid sternum.
The team arrives, the wife flees the room, and I yell "Paddles first! Paddles first!" I start doing CPR. Our top gun nurse is on and we are a smooth team. The pads go on the chest and we defibrilate. Nothing. More CPR while the machine charges and we fire again. Got him--QRS's on the monitor and in seconds he's awake and fighting us. Minutes later he's relxed and I'm chatting with the family. Then off to cath lab.
Good, good, God damn Emergency Medicine!
U-561
posted by U-561 at 9:19 AM
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