Friday, April 16, 2004

Graveyard shift in the ER

It was 4.45 am. I was working the graveyard shift in the emergency department. The call that came in warned us: 2 ST elevation MIs coming in.
Mr. X was a guy in his 60s. Typical of a Minnesotan farmer, he was big, overweight to be precise. Pretty stoic, but he stingily offered his story, he was awakened by crushing chest pain. Never had it before. Never had any cardiac problems.
The EKG rhythm strip from the ambulance told us all we needed to know. ST elevation. The 12 lead confirmed it. We call it ‘tombstoning’ patterns, for the ominous meaning it held.
The CCU fellow assessed him in the ER. We did what we had to, and got him ready to go immediately up to the cath lab to have emergency angioplasty. Not bad, if you consider that he was wheeled in only minutes ago. He looked pretty comfortable. For now.

“Ohh, I don’t feel too good.”

I look at him, and find him ashen-faced. Suddenly he’s out like a lamp. Alarms go.
“V-fib!” someone yells. Essentially, unless we bring him back, he’s dead.

Charge to 200J. Clear.

His body jolts with the energy being pulsed into his chest. A small stream of blood trickles down his mouth, likely from his biting his tongue with the shock.
Normal sinus!

He opens his eyes. “What happened?”

He’s back, and 30 secs later he’s off to the cath lab with nurses and a cardiac monitor.
I catch myself thinking, this patient was dead and back in that 15 seconds. No chance a patient in Malaysia could have had this benefit. Silently, I say a prayer for him.

I wish I could offer my patients back home the same benefit. At the same time, I'm grateful that medicine has progressed, at least in the USA, to such an extent. I'm frustrated, that the dean of my undergraduate school in Malaysia, a hematologist who died of an MI while waiting in the ER of the University Hospital of KL, probably could have been saved had we had the resources.

Cath lab in 30 mins? What a joke. We don't even have crash carts there.

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