Worn Down

At a doctor’s office, there is a man in his 80’s with a BP of 70, dizzy, not feeling well for two days. I take his pressure — 68/34. He is pale and gray and does not look well. His capnography number is in the low to mid twenties, showing poor perfusion. I do a twelve lead and leads V2-V3 catch my attention.

The shape is often indicative of a posterior MI. I put a lead on his back and this is what it looks like.

I would have liked to have gotten a better tracing, but we are going on a priority. I toss him some aspirin and continue running fluid in through the IV. His lungs are clear. I call the hospital and say I have a possible posterior MI. I am hoping this will start the process of getting the cath lab ready for the man becuse that is what I believe he needs. I look at him again. He says nothing. He looks beat, like he knows he is really sick, and knows that he doesn’t have the strength to do anything more than let whatever is happening either kill him or let him live. It is not in his hands. What is he thinking? Running through his life, I’d guess

I show my 12 lead to the nurse, and she quickly gets an old 12 lead off the hospital computer. A big change since the last one was done a month ago. She calls the doctor over and I give him my report.

When I left I thought he was jusrt about to be taken to the cath lab, but when I checked back later, the nurse told me they had sent him up to the Intensive Care Unit. She said he had nothing left to cath. He had had so many procedures in the past.

Cardiac calls are my favorite because they involve such a combnation of skills. Knowledge to be able to identify the MI, skills to put in two IVs en route, and experience to be able to move the call quickly from scene to the hospital, and then persuasion to be able to get the hospital to recognize what you have and get the cath lab ready. This guy just was too old and worn down to be helped.

He was still alive the next day, but the nurse said they expected him to die.

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