Upstream Problems

He had been through this before. The patient, a 57-year-old man, had come through the doors of this emergency department many times. He had a favorite seat in triage. He knew what questions the nurse would ask him once he was in a room, and that the doctor would repeat those same questions. Then tests and labs, then moved upstairs for a couple of days before going home, hopefully feeling better. He knew all of this. Today, though, everything he thought he knew was wrong. He had once considered himself lucky. He even survived a gunshot to the chest as a young man. But that notion had faded long ago. His health had been getting worse for years. He suffered with diastolic heart failure, COPD, and stage 3 chronic kidney disease brought on by years of poorly treated hypertension and diabetes. He had been told during one of his stays in the hospital that he had depression. He didn't doubt it. He had resigned himself to never getting completely well, but the past couple of days had been even worse. He had not slept in days, and was extremely fatigued. He was unable to catch his breath, and was in mild distress. Oxygen saturations were 70%, which improved with supplemental oxygen by Oxymizer. He was not having any chest pain, and his blood pressure was in the 100s mm Hg systolic, way below his baseline and surprising given that he had not taken his medications for weeks. Exam was remarkable for generalized edema, diffuse crackles, and JVD elevation. Creatinine was nearly twice his ...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs