The Narrow Gate

The patient first felt winded one night after doing the dishes. She was breathing so hard by morning that she was barely able to get out of bed. And a cough had started. “The flu” went through her mind. She stayed home from work to rest, but all day she just couldn’t catch her breath. The cough got worse and was making her chest hurt, and she felt her heart racing. She was exhausted by evening, but knew she wasn’t going to be able to sleep. The temperature was below 0°F outside, but she bundled up and drove herself the three miles to the emergency department. Barely able to speak by the time she stepped up to the triage desk, she was only able to get out “You need to slow my heart down.” The nurse knew that look. The patient sat down hard in the wheelchair rescuing her from the burden of standing. “Medical Resus” was paged overhead, and the nurse rushed the patient back. A (airway) was clearly intact as the patient was placed on the cart. Everyone knew that B was going to be problem. The monitoring cables were on before most people noticed, and there was an uncomfortable pause for several seconds while everyone in the Resus Bay waited for the first SpO2. 68%. Heart rate 146 bpm. That’s all it took. An IV was placed, and the patient was intubated in the next few minutes. Attention turned to the cause of respiratory failure. An ECG and chest radiograph was obtained, and are shown in Figures 1 and 2. Figure 1. Presenting ECG. Figure 2. Chest radiograph. The ...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs