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The thread on the ovarian cyst rupture that lead to hemoperitoneum and shock, got me thinking. We need a thread on things specialists told us couldn't happen, that did happen. There's been many times consultants questioned me, doubted my instincts or just plain told me that what I was seeing and knew, was wrong, and then they turned out to be dead wrong.
Probably the most blatant and glaring example that comes to mind, was a guy who according to EMS told them he was having chest pain, then when they arrived and walked in the room, he clutched his chest and collapsed. They put the paddles on him, it showed V-fib and they shocked him back to sinus. By the time they got him to me he was awake and complaining of chest pain, again. I got an EKG right away and it was normal. Right before my eyes, he said, "I'm having chest pain," and again clutched his chest and got this crazy look on his face. We looked on the monitor and it showed V-fib. We shocked him and fortunately got him right back into sinus rhythm, again.
So, at this point, I'm thinking, okay, great. This guy is obviously having an MI, and not just any MI, but 'the big one' and the cool thing is, if we get him to the cath lab right away, this will be one of the cleanest 'lives saved' I've ever had in my career.
So I repeat an EKG; still normal (but who gives af, right? since people have non-STEMI, non-Q wave MIs all the time, and when I repeat the next ekg or two, the ST segments will obviouly go up, because this is the most obvious no-brainer MI I've ever seen in my life, and we’ll get him off to the catch lab.) So, we start the classic chest pain, stemi protocol and put a call out to interventional cards. Now mind you, this is day time. It's not 3 am and it's not everyone's favorite holiday, either. I'm anticipating virtually zero pushback.
About 60 seconds later, cards calls back and while I'm answering the phone, the guy goes into v-fib again and me and awesome-nurse pop him with juice again, saving this guy's life, AGAIN. Then, unf***ing-believably, the cardiologist starts lecturing me on “what MI's are, that this guy is obviously not having an "MI" and that it's obviously not an MI, because it's an arrhythmia and that the two have nothing to do with either other, and was I a ***** because I must have slept through the ‘What is an MI?’ lecture in residency.” He then tells me to call non-interventional cards.
Dumfounded, I call our non-interventional cards person who was even more pathetically worthless and tells me to call Medicine, because, "Anything could be causing this arrythmia and since it's 'obviously not a STEMI' to have medicine admit him." During this 60 seconds, the guy V-fibs again, and amazingly we get him back. Again.
At this point, I'm keeping my cool, because I know, that with one more EKG, the ST segments will certainly go up and then I can get ------bag of the century to actually take this guy to the cath lab and help me save this guy's life. So I repeat and EKG and '--ck! It's still normal!" So I break down and call the hospitalist, tell him the insane story I'm living and he's like, "Wtf? You want me to admit and refractory V-fib that's having an obvious MI?"
Yep, I say, and thankfully he's a stand up guy, unlike the insane gaslighting cardiologist on call, so he comes down to help me out. By this time, I've intubated the guy and have defibrillated him 7 times, SEVEN ----ing times! and back to sinus every time. He's got a strong pulse.
The hospitalist walks in the room and we're both, shaking our heads, disgusted at the insane world we live and work in right now. The nurse hands us another EKG and guess what it shows?
Take a wild ----ing guess what it shows?
Yep, a STEMI.
Imagine that?!?!?! /sarc
So, I tell him, "Dude your turn. If I have to call this ------bag cards crew one more time, I'm going to lose it and get fired. You call 'em."
He calls them and doctor-horrible-human-being takes him to the cath lab.
I go home in disgust.
Next day:
"Guess what? That guy had a 95% LAD."
Yeah, no ****, Sherlock!
A decade later, I still remember the patient's name. He walked out of the hospital 100% neuro intact. A clean life saved, despite a valiant effort from two cardiologist to gaslight me into letting him die.
Moral of the story: You’re just as smart, of not smarter than them. Stick to your guns.
Probably the most blatant and glaring example that comes to mind, was a guy who according to EMS told them he was having chest pain, then when they arrived and walked in the room, he clutched his chest and collapsed. They put the paddles on him, it showed V-fib and they shocked him back to sinus. By the time they got him to me he was awake and complaining of chest pain, again. I got an EKG right away and it was normal. Right before my eyes, he said, "I'm having chest pain," and again clutched his chest and got this crazy look on his face. We looked on the monitor and it showed V-fib. We shocked him and fortunately got him right back into sinus rhythm, again.
So, at this point, I'm thinking, okay, great. This guy is obviously having an MI, and not just any MI, but 'the big one' and the cool thing is, if we get him to the cath lab right away, this will be one of the cleanest 'lives saved' I've ever had in my career.
So I repeat an EKG; still normal (but who gives af, right? since people have non-STEMI, non-Q wave MIs all the time, and when I repeat the next ekg or two, the ST segments will obviouly go up, because this is the most obvious no-brainer MI I've ever seen in my life, and we’ll get him off to the catch lab.) So, we start the classic chest pain, stemi protocol and put a call out to interventional cards. Now mind you, this is day time. It's not 3 am and it's not everyone's favorite holiday, either. I'm anticipating virtually zero pushback.
About 60 seconds later, cards calls back and while I'm answering the phone, the guy goes into v-fib again and me and awesome-nurse pop him with juice again, saving this guy's life, AGAIN. Then, unf***ing-believably, the cardiologist starts lecturing me on “what MI's are, that this guy is obviously not having an "MI" and that it's obviously not an MI, because it's an arrhythmia and that the two have nothing to do with either other, and was I a ***** because I must have slept through the ‘What is an MI?’ lecture in residency.” He then tells me to call non-interventional cards.
Dumfounded, I call our non-interventional cards person who was even more pathetically worthless and tells me to call Medicine, because, "Anything could be causing this arrythmia and since it's 'obviously not a STEMI' to have medicine admit him." During this 60 seconds, the guy V-fibs again, and amazingly we get him back. Again.
At this point, I'm keeping my cool, because I know, that with one more EKG, the ST segments will certainly go up and then I can get ------bag of the century to actually take this guy to the cath lab and help me save this guy's life. So I repeat and EKG and '--ck! It's still normal!" So I break down and call the hospitalist, tell him the insane story I'm living and he's like, "Wtf? You want me to admit and refractory V-fib that's having an obvious MI?"
Yep, I say, and thankfully he's a stand up guy, unlike the insane gaslighting cardiologist on call, so he comes down to help me out. By this time, I've intubated the guy and have defibrillated him 7 times, SEVEN ----ing times! and back to sinus every time. He's got a strong pulse.
The hospitalist walks in the room and we're both, shaking our heads, disgusted at the insane world we live and work in right now. The nurse hands us another EKG and guess what it shows?
Take a wild ----ing guess what it shows?
Yep, a STEMI.
Imagine that?!?!?! /sarc
So, I tell him, "Dude your turn. If I have to call this ------bag cards crew one more time, I'm going to lose it and get fired. You call 'em."
He calls them and doctor-horrible-human-being takes him to the cath lab.
I go home in disgust.
Next day:
"Guess what? That guy had a 95% LAD."
Yeah, no ****, Sherlock!
A decade later, I still remember the patient's name. He walked out of the hospital 100% neuro intact. A clean life saved, despite a valiant effort from two cardiologist to gaslight me into letting him die.
Moral of the story: You’re just as smart, of not smarter than them. Stick to your guns.
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