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 gonna do it.
especially since my major defense mechanism in dealing with the stress of my job
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 mask...now 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
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
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
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-->
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"
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"
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.