>S**t! I DO have to know the Frank Starling Curve
>We ran a code sim as part of class the this week and it was one of the more educational sims sessions I have done in medical school. Keep in mind, none of us have done ACLS training yet…
A guy presented with the typical story for MI and we got an EKG which showed elevations in the precordial leads. Us four students were standing around the bedside trying to remember what MONA stands for when all of a sudden the patient’s pressures stared to drop… 120…110….100…90. In a knee jerk reaction I brazenly shouted out “IV Fluids wide open!” Secretly patting myself on the back for recalling this basic principle of resuscitation, we stood back and waited for Mr. Sim to pull out of his nose dive. But the opposite occurred, he continued his systolic nose dive at an even greater slope, crasheed through 60 down through undetectable, and quickly coded. Tada! You sir, have killed your patient!
Now, this is (hopefully) something that an experienced clinician would have avoided. Given that this sim was part of our advanced physical diagnosis course, it may have behooved us to actually perform a physical exam, instead of getting all bogged down in the logistics of resuscitation. If we had, we would have heard some soggy sounding lungs. Little did we know, that the patient was was in advanced CHF when he presented.
So what happened, and what SHOULD we have done? Lets look at that bitch of an inverted U, the Frank Starling Curve.