Monday, January 11, 2016

Rocket Man

EMS dropped off a LOL with late afternoon "weakness", the universal label for non-specific maladies  affecting frail elders who have been left to fend for themselves most of the day.  They are  found in their La-Z-boy recliners, where they have spent the afternoon sleeping, by family members returning home for the day in a state generally described as "confused", or "unresponsive".  Often they are "fatigued".  Usually they have numerous co-morbidities, a med list as long your arm, and have "not eaten all day".  Cue the turkey sandwich.

This particular day found me floating in the department without an assignment, helping out as necessary as Float Fairy (or Everybody's Bitch).  Floaters mostly do EKG's, triage ambulance patients, and transport patients to other departments or inpatient units.  Or start a lot of IV's.

The LOL was brought by paramedics I have known for a long time, who are experienced and known to be thorough.   As I had taken the radio patch,  I owned the patient until I could find the resource person to assign another nurse.  Every room in the department was full and we were on overflow hallway beds.  This is never good.

"OK to triage her in the hall?"  I asked.  Sure, no problem she's been stable enroute was the response.

Except she had a heart rate of 30.  THIRTY.  And hypotensive.

A monitored room was cleared immediately.

I thought the EKG looked tremendously weird.  I checked and rechecked my lead placement.  The elderly patient roused a bit.

She whispered, "Situs inverses".

Ah.  This is a very interesting condition in which the organs of the abdomen are backwards, and in this case a mirror image.  Cardio came right away.

I had done (and labeled correctly for posterity) an EKG done the right way, the reverse way, and another weird way that I can't even remember.

As I excitedly whirled to present the latest tracing to the taciturn cardio guy, I found that he had sidled right up next to me.  I hate a sidler, I really do.  My fist connected with his groin, and he doubled right over, being a small an somewhat frail individual as all brilliant people seem to be.

Ooof.  Had he been taller than me it would have been a glancing blow to the upper leg, but no.  I muttered an apology, he muttered "no worries", and we both continued on as if nothing happened.

Man, there are a lot of people I would pay to punch in the rockets, but he wasn't one of them.  I felt kinda bad.

After I laughed for about a half hour.

Saturday, January 9, 2016

Chicken Seizure Salad

BPOM told me:

 "I took that lady on the ambulance last Tuesday, we were called out for a unresponsive.  She was sitting in the car and said she thought she was going to have a seizure.  So, we transport her and on the way she started clucking like a chicken.  buck buck buck buck aback!!  Buck AAAch!!  BUCK AAAACK!!!!! While shaking her hands and arms.  After about 20 seconds of this, she stops, looks around calmly and asks, "What happened?"   "Well, you were clucking like a chicken".  "Oh, I had a seizure then.  I don't remember any of it".