I know on some planet, people ease into their days at work. They get a cup of coffee, check a few emails, chit-chat the shi-shat at the water cooler or something like that. Now, don’t get me wrong, I truly enjoy a delicious mocha. Coffee is, after all, my favorite caffeine vehicle (my personal drug of choice).
However, on one fateful day, in the first four seconds of my arrival (and before said coffee) I realized it was not going to be the sunniest Care Bear filled lollipop day of my life. The ED charge nurse rushed me like a feisty, pissed off bulldozer. Her first words to me were: “Yougotta furnnyGobber Summa PRIORITY ONE gobber bobby fabba!”
In case you didn’t know, I wake up slowly. I was not quite catching everything she said. Something something heart rate fast, something something blood pressure low.
A 26 year old female with a fast pulse and low blood pressure? Psh, no biggie. She probably is just anxious and normally runs a little low.
She did appear anxious, but a heart rate over 200 I think will make anyone a wee bit anxious. I know it got my giblets a little kerfluffled (it’s a word, click it punk!).
So, in order to de-kerfluffle my giblets, I ran into the room and quickly assessed the patient. She was a bit portly, perhaps she had extra giblets herself. To use my very best medical and doctor speak, she looked like crap.
Her pale, sweaty face matched with her rapid breathing and the continuous blaring of monitor alarms did little to instill a sense of calm in the room. I took a rapid H&P and checked her out head to toe, finding nothing but an extremely fast pulse and a young woman with eyes pleading for help.
There is an expression in poker: “It’s better to be lucky than good.”
What followed was a mixture of luck and awesome.
I called in my minion (click for article on minions), who scuttled over to watch. I then put my hands on her abdomen and told her to push against me as hard as I could. I proceeded to push on her abdomen very hard. I literally lifted myself off the table while pushing on her abdomen. I forced the patient to do a vagal maneuver to try to slow down her heart rate (click (it’s web MD, it must be true!)).
I had never done that maneuver before, but it made sense in my mind since it would force the patient to push extremely hard with their stomach (which is what you want for vagal maneuvers).
Then it happened.
Her heart rate dropped. From 220, to 180, to 160, to 110, to 80. And she felt 100% better.
Awesome. Especially with the medical student watching. I told her that when she repeated the story to have me wearing a cape (lightly flapping in the breeze).
It was one of the cooler things I had done in the ER in a long time.
All that before I got my coffee. And, if you were wondering, below is how coffee works (and below that you can LIKE me, or LIKE on the right column to follow on facebook)