…and you lose some
I’m standing outside a room, finishing a chart, when the nurse pops her head out and asks me to come take a look at this guy. Early sixties gentlemen, from the other side of the country, in town for a meeting, complaining of chest and jaw pain. He’s pale, sweaty, hand resting across his chest, clenched in a fist, short of breath but awake and talking. The EKG is being hooked up, but even before it prints out, there are those no doubt about it ST elevations on the screen. I take a 20 second history, excuse myself to go call for back up, telling the nurse to start some nitro on my way out. I slip the EKG under the nose of the attending, tell the clerk to activate the cath lab, when some body calls from the room “BRING THE CRASH CART”. I take that as my cue to grab an airway kit and another 20 seconds later am back in the room to find the patient in V Fib. We code him for a good long while, do all the things that need doing, but none of it works and he never regains a pulse. To be forthright, and admit my defeats as well as victories, I failed in my attempts at getting an airway and anesthesia had to finally place one.
This story is nothing new to anyone who has worked in emergency medicine. I only write about it as it struck me afterwards, that this might have been the first time that a patient “read the book” about his disease and presented exactly like you learned they would when reading the textbook. He could have been wearing a sign around his neck that said STEMI and it wouldn’t have been more clear. Usually there is something that is slightly different about they way a patient presents, never is it so black and white as this guy was.