One of said docs personally accompanied one of his patients to our ED while I was working. The patient was dizzy and having chest pressure. He wanted to manage her himself. He didn’t need any help from the ED physician.
Nurses got the vital signs. Initial blood pressure was 66/palp. Initial heart rate was SVT at 190-200. The patient was sweating like Chinese officials trying to verify Jiang Yuyuan’s age.
The staff doc ordered thrombolytics — STAT. The nurse came out of the room, grabbed me by the arm, and pulled me toward the room.
“Need any help, doc?” I asked.
“No, we’re fine.”
“Why are we giving thrombolytics to someone whose EKG doesn’t show an MI?”
“Not giving them – just having them ready.”
“No problem. Call me if you need any help.”
When we got out of the room, I told the nurse to suggest that the doctor cardiovert the patient.
She did. No go.
There is no way that the doc would give a shock without knowing what the patient’s coagulation status was.
The doc ordered Adenosine. No change.
The doc ordered Amiodarone. No change.
Then the doc ordered Dopamine drip. Still no change.
I’m sitting at the nurse’s station listening to the monitor clipping along like a metronome on crystal meth.
Then I hear a stat page for the cardiologist to come to the ED.
I mozy back over to the room.
“Yes. everything is fine” says the doc – holding the monitor paper and rifling through it like he was reading a ticker tape.
The cardiologist arrived in no time.
As he was walking by, I loudly asked the nurse “they called the cardiologist because they’re going to SHOCK the patient, right?”
I caught the tails of his white coat as he whisked through the door of the room.
Then the family doc shouted “Someone call the lab and find out what’s taking them so long with those coag studies!”
Then the nurse walked out of the room and threw her hands up in the air.
The patient’s blood pressure hit 72/palp and the cardiologist wanted to give 4mg of Morphine IV push. The nurse refused.
Then the cardiologist set off a flurry of activity throughout the hospital by asking for something that no one could find. Nurses looked through drawers in the ED. They called the ICU and no one could find it up there, either. The floor nurses didn’t have it, either.
With the medical metronome still beeping away, a nursing student who was eating lunch in the cafeteria came running up to me and handed me the item with a sigh of relief.
The item that the cardiologist desperately needed was the 2008 ACLS protocol.
I had a good half dozen pithy comments to make to the doc as I walked into the room with the book. But I didn’t. I’m such a chickenshit sometimes.
Instead, I opened the page to the “Tachycardia” algorithm and told the nursing student to go in the room and tell the cardiologist that it looks like the patient needs to be shocked. That way she could look like the star.
Even us dumb ER docs have our moments.
Or as one of my professors used to say … “even blind squirrels find nuts once in a while.”