A Trusting MD

The other day we brought in a patient in pretty severe respiratory distress to the ER. She was showing all the signs and symptoms of a patient with pneumonia and was coughing so hard that she caused a pretty bad nose bleed. After we had placed her in the bed in the ER we were finishing up our paperwork at the work station in the ER. The ER physician, without looking at the patient, asked us pointedly if she was circling (commonly called circling the drain referring to the patients deteriorating condition). She asked us if the patient needed to be intubated or if it was something that could be treated without intubation. It was nice to have a doctor trust your judgment.

Later that morning we brought in a man with low blood pressure and a slow heart rate. We were unable to establish an IV so we just quickly transported him to the hospital. The patient was not complaining of anything other than the inability to burp. I know that there may be paramedics, RNs, or doctors out there that would immediately start wondering about cardiac involvement. They would be right. When we finally did a twelve lead ECG it came back showing that the patient was having a massive heart attack. The patient spent a total of twelve minutes in the ER before being rushed to the CathLab. The doctor congratulated us on our rapid transport of the patient but we had to admit that we had missed the heart attack having been too distracted by the slow heart rate and low blood pressure. In the end the patient got exactly what he needed, a fast way to get to the hospital. It was a good call from which to learn.