Holy Moly!!!!

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by ERNurse752
Dec 11, '02 Views: 2,292 Comments: 15

40-something y/o/w/m w/ hx HTN comes in to the ER via ambulance for H/A. Took a couple Darvocets at home without relief.

Doc sees pt...is still in room when pt proceeds to seize...

Discover pt is pulseless...v-fib...one thump, 4 shocks, and a round of drugs later, we get a rhythm back...with tombstones.

He's having an inferior MI...never had ANY chest pain, sob, n/v...NOTHING!!!!!!!!!!!!!!!

Luckily, this happened after 0600, so the cardiologist and cath lab team were in-house and got him down to the lab really fast.
He also woke up, was a/o, and breathing on his own...

Talk about being taken off guard...I'm back tonight, so I'm going to follow-up on him to see how he's doing now and what they found in the cath lab.
About ERNurse752

Joined: Oct '01; Posts: 1,499; Likes: 287
Specialty: 8 year(s) of experience

15 Comments

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Dec 11, '02
Occupation: returned nurse Joined: Nov '98; Posts: 7,097; Likes: 5,234

Sounds like this guy is alive due to your ERs vigilance. All of us have seen patients with atypical MI symptoms. They always give me this really bad feeling, like I said in past post the hair stands up on back of my head.
Dec 11, '02
Joined: Oct '02; Posts: 60,384; Likes: 16,559

Great Job! It's amazing how quick things happen sometimes. one can never let their guard down.
Dec 11, '02
Occupation: Hospice Joined: Dec '02; Posts: 103

Keep us updated ERNurse, and Good job!!!!!!!! Well done
Dec 12, '02
Joined: Aug '02; Posts: 250; Likes: 36

I'm at the bank today, and one of the tellers whispers to me that one of the other tellers is having cp and numbness and tingling L arm. teller is about 40 y/o/w/f,smoker. So we talk, and after she explains her sx's and other meds she takes, I advise her to see her doc, she's not interested, ok, call your doc then, tell him your sx's. This is not stuff to play around with. I lost two co worker's 1 nurse, 1 cna, because of "oh it's nothing" attitudes.
also had a 40 y/o/w/m literally jog into the e/r one morning c/o SOB and increased anxiety while doing his morning run, he was having a MI. It's freaky when it happens, but then again at that time I was an adrenalin addict, and coutdn't wait for the next one to arrive.
Dec 12, '02
Occupation: RN, ER Case management, precertification. Specialty: ICU-Stepdown ; Joined: Dec '02; Posts: 862; Likes: 53

Wow! Hell of a catch!

Please do keep us informed as to the progess of this little miracle.
Dec 12, '02
Occupation: allnurses Asst Community Manager, APRN Specialty: 25 year(s) of experience in Nephrology, Cardiology, ER, ICU ; From: US ; Joined: Apr '00; Posts: 53,361; Likes: 26,175

I love the adrenaline rush too...great save!!!!
Dec 12, '02
Occupation: RN Joined: Aug '01; Posts: 2,276; Likes: 42

Did you have time to change your underwear before the rest of the shift? :roll

Good save!!!:kiss
Dec 13, '02
Specialty: 8 year(s) of experience ; Joined: Oct '01; Posts: 1,499; Likes: 287

Well, went up to CICU to talk to the pt the other night...

He coded 4 more times in the cath lab, after going into pulseless VT. Got tubed as a result. Was extubated 8 hours later. No neuro damage...but...

Had a 100% occluded RCA, at the extreme proximal end, so there was a lot of heart muscle below it that got deprived. They ballooned and stented it. He also had a 50% circumflex, which they left alone.

Ejection fraction in the cath lab was (gulp) only 25%. (50-60 being normal, CHF starting around 40). They're hoping that it will increase some, and that it's so low from his heart muscle being "stunned" from all the trauma.

He was still on an Amiodarone gtt, and still on his Heparin and Integrilin. His O2 was weaned down to 2L n/c, with spo2 of 94%. He said he was feeling pretty good.

He was scheduled to go back to the cath lab today for AICD placement.

They told him he'll be off work for at least a few months, and it's pretty up in the air if he'll ever be able to go back to EMS. He was planning on going to paramedic school this winter/spring.

This guy had done a treadmill and some other tests that he wasn't sure of at another hospital about a week ago, and they were all normal.

Scary...
Dec 13, '02
Occupation: staff nurse med/surg Joined: Nov '02; Posts: 346; Likes: 3

Great save ER nurse. you are amazing. Thanks for keeping us updated. This was my first time to this thread. I found myself scrolling down as fast as I could to see if you had come back with an update. I'm so happy he made it, thanks to you!
Dec 13, '02
Occupation: CCU RN Joined: Sep '02; Posts: 1,039; Likes: 10

Awesome save!!!!! Keep us updated!!! Sounds like he is getting awesome care all the way...
Dec 14, '02
Specialty: 8 year(s) of experience ; Joined: Oct '01; Posts: 1,499; Likes: 287

Nah, not thanks to me...it was a major team effort...if it was bound to happen, it happened at the right time for everything to move quickly.

I'm back Sunday, so I'll update again!
Dec 14, '02
Occupation: Nurse Educator Specialty: 16 year(s) of experience in Gerontological, cardiac, med-surg, peds ; From: US ; Joined: Mar '01; Posts: 12,037; Likes: 6,467

Those RCA occlusions (right-sided and inferior infarcts) can have very strange manifestations, especially in women. That's why women often have poorer outcomes post MI's (higher mortality and morbidity). Oftentimes, only sx: bad abdominal pain, SOB, sky-high blood glucose, shoulder or intrascapular pain, high lactic acid (over 10--ominous). Sometimes no symptoms at all (especially in diabetic or insulin-resistant patients)--until they drop over dead from sudden cardiac death (dysrhythmias) or have symptoms of end-stage CHF. One very experienced ER nurse told me that if someone comes in with "jaw pain"--beware--it may be "the big one!!" She told us of one patient who only was hurting in one or two fingers--no other symptoms--and was having a massive MI!!! I have never heard of "headache" pain signifying an MI before! This whole subject is fascinating.

Holy Moly!!!!

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