nerding out

posted on: Wednesday, September 12, 2012

i don't often talk about my job on this here blog
part of that is due to the fact that my patients are real people
and God forbid i don't do a good enough job covering up any identifying information
and they read this blog and realize i'm talking about THEM
not cool.
not professional.
not gonna do it.

especially since my major defense mechanism in dealing with the stress of my job
is humor.
sometimes you just have to laugh at the situations people find themselves in.
it's how i cope.
and sometimes, the stories are really funny.
but not everybody gets that.
so i just avoid the topic all together.

but it occurred to me that, in all other things,
i try really hard to be honest on this blog.
so for me to completely leave out what i do,
is pretty much a lie of omission.

so in an effort to open up about my job,
here's a little story about medicine
and how great it works when you use it right.
(let's see if i can make this make sense.)

the other night, a patient came into the ER
(duh. where else would i be?)
he was complaining of chest pain and saying he couldn't breathe
i believed him, because he looked like shit
grey, diaphoretic (sweaty), clutching his chest,
using all of his accessory muscles in his chest and neck for every breath
and his oxygen saturation was only 72%
he said he was diabetic with high blood pressure and that he had asthma
i listened to his lungs while a tech got an EKG
his lungs sounded really junky (rales is the dr. word), like they were full of fluid
not really wheezy, like he was having an asthma attack
his oxygen saturation got better with a face 100%
the EKG was really poor quality, 
since he was using so many of his chest muscles to breath
but it showed he was having a heart attack
and his blood pressure was thru the roof: 237/138
crazy high.
and his heart rate was in the 140s
we gave him a Nitroglycerine tab under his tongue
and Aspirin to chew
and tried to get a better quality EKG 
so we could decide if we needed to activate the cath lab
the repeat EKGs were more normal, and argued against him having a heart attack
but his blood pressure and heart rate were still crazy high
and he was still working to breathe

even though the subsequent EKGs looked better,
the patient still didn't. 
and it was hard to ignore that first one.
so we activated the cath lab and the cardiologists were on their way in
in the mean time,
we started a nitroglycerine drip
and put him on a BiPap machine to help him breathe

here's why:

Nitro(glycerine) works to dilate your blood vessels
this is good because it makes all the vessels in your legs and arms larger
so they accept more blood and take it away from your heart
this makes it easier for your heart to work
and decreases your blood pressure
nitro also specifically dilates your coronary arteries
this helps more blood get to your cardiac muscle
which is good when you're having a heart attack
(that's the chest pain you get during a heart attack: 
the cardiac muscle starts to hurt as it dies because it's not getting enough blood)
so Nitro: lowers blood pressure
makes heart work less
gets more blood to heart
make sense?

BiPap is a machine that attaches to a face mask
and it blows air into your lungs
lots of air when you're taking a breath
a little less air when you're not taking a breath
this helps keep your lungs open, so they don't collapse when you exhale
this pushing of air into your lungs also helps keep fluid out of them
the air is there, so the fluid can't be
(i'll explain more about fluid in the lungs in a sec)

back to our guy:
by the time the cardiologists arrived
the EKGs had totally normalized
the patient's lungs were crystal clear--no fluid or rales
and his blood pressure and heart rate were lower-- 170s/90s and 80s

now, as a refresher, this is the path that blood takes around your body:
deoxygenated blood: veins-->vena cava-->right atrium-->right ventricle-->
pulmonary arteries-->lungs
oxygenated blood: -->pulmonary veins-->left atrium-->left ventricle-->aorta

turns out, he wasn't having a heart attack
he was having what we call a Hypertensive Emergency
basically, his blood pressure was so high
that his heart couldn't effectively pump out blood against all that pressure
this was causing the blood to back up into the lungs
and the pressure of the blood in the pulmonary circulation
was so high, that it was causing fluid to leak into his lungs
which is why he sounded like there was fluid in his lungs
..because there was.
it's called Flash Pulmonary Edema

the Nitro drip and the BiPap machine saved this guy's life
isn't medicine awesome?
well, when you know how to properly use it
(side eye personal physician of Michael Jackson)

in Emergency Medicine,
we have a few phrases to describe the emotions 
that I was going through during this patient encounter
"elevated sphincter tone"
"need a change of pants"
"pucker factor"

they all describe how terrified you are as a doc
when your patient is knocking on death's door like this
and they're sort of gross
this is a profession dominated by men, after all.

for me, i prefer to describe it like a lady:
"my heart beats faster"
Faster by Matt Nathanson on Grooveshark
he says it well

hope you enjoyed this small glimpse into my every day
this is what i'm doing when i'm not blogging
it's actually what i'm doing right NOW
since i scheduled this post
because i'm at work.


  1. thoughts:
    a) your job is major. my decision? what to feed parker for lunch. yours........ are bigger.
    b) you're smart.
    c) there was a lot of medical jargon there that i've never heard before.
    d) i wish you could tell the funny stories (but i understand why you can't.)

  2. i LIVE for these posts...its the science junky in me. I read every word, see if i know it before you explain it, memorize what i dont know.

    gosh i need to get back to the states in get back into science. im bored.

  3. i like want to send you my medical records because i feel like you'd REALLY enjoy reading my cardiac history.

  4. Wow! Seriously that is crazy!

    I always think that I'd be a mess if I was a doctor and was faced by something like that. Then again two ish years ago I was on the way home from a friends and a car had gone into a ditch on the other side of the road. I was only a first aider but the difference between that and nothing until the Ambulance got there was enough for me to U turn in the road and park with my hazards on so that people coming towards the accident were aware.

    My friend who was in the car with me was like "The second you got out the car you were so focused." I just remember getting out the car giving her my car keys and my phone so that she could be an extra pair of eyes and if we were in danger she could do something about it. There was just one casualty everyone else was in shock so we talked about anything that came to mind until the ambulance arrived and then they took over. We often retell the story given how scatty I can be sometimes lol.

  5. I'm with Bridget- you're a superstar! I seriously just learned so much. Who knew that sitting here, trying to stay out of my packers' way, I'd learn what Flash Pulmonary Edema was, and why your chest hurts in a heart attack. Grey's Anatomy NEVER tells us the details!! :)

  6. Amazing. I can't even imagine how doctors can be so smart & save people's lives. And I agree- you don't learn about these things on Grey's!

  7. this came entirely too soon after a cardio block exam to enjoy...maybe after a nap i'll like medicine again. :-)

  8. You are basically the shiz. Way to save a man's life!!

    Sad story... my grandma died on a trip with my family to D.C. She started having chest pains outside the building where they print money (can't think of the name). They rushed her to a learning hospital where they were going to do an angioplasty. But before they got her into surgery, she had a massive heart attack and died. My dad told us that when the doctor came in to see her before the surgery (before she died) he yelled at the intern for not giving her aspirin. And I've always wondered if the aspirin would have made any kind of a difference.

  9. ah I do think it's a good idea to keep work off the blog. I do it too, and my jobs are nowhere near as important as life-saving medicine.

    that said, thanks for sharing! I almost felt like I was watching (reading?) an episode of House. Kind of cool. I have so much respect for doctors.

  10. yeeeah. love knowing how everything works (and totally re-tested myself on the blood flow path). after my client had a heart attack last year i totally want to be able to carry a nitro tab in my bag, but i'm pretty sure that's not allowed. soooo aspirin it is. i commend you. that night scared the shit out of me. can't imagine doing it every day... high five.

  11. Wow, it was great to read about what you do Emily! It's a pretty amazing thing you do. I mean, there aren't many people out there who can say they actually save lives! Gosh. Bravo to you and your hospital!!
    I guess working in a hospital makes ever being a patient there less of a big deal?

  12. Oh my gosh, this was the coolest thing to read.
    In high school a&p, writing case studies was my favorite! And that this is real and you saved his life... incredible. So impressed.
    Way to go, girl.

  13. wow ! you rock!! also congrats- you're the winner of the travel print over at hanna margaret's blog :) :) yay!

  14. Amazing. I feel smarter for reading this

  15. tell me bedtime stories of work days, please? you're awesome.


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