giving thanks (day 1)

Since this is Thanksgiving week, I thought it would be appropriate to post things I am thankful for.


On Friday at work we got a call for a 36 year old male having chest pain. Since normally young people with chest pain is BS (usually drunk) we groaned, left the middle of our tv show and headed over.

When we got to the house we met a large man who didn't look so great. My gut said he was having a heart attack so we went to work. The symptoms said yes, but the signs said no. Vitals were stable, EKG/12 Lead were normal sinus rhythm with no S-T abnormalities. I gave him some Aspirin and a Nitroglycerin and we moved him out to the Medic Unit. (to get to the point of this, jump to the * paragraph)

I looked for and IV, the big guy had no veins. Vitals were reassessed and his BP had gone up, so I gave him a second Nitro. I monitored him, kept looking for an IV and finally got a crappy one right before we got to the hospital. We walked into the ER with our probable heart-attack-on-a-cot, they sent us back to room 11. I was offended for my patient. (sidenote: people who they are actually worried about go to room 1 or 2) As I tried to give report to the nurse and tell her why I was 99% he was having a heart attack, she kept ignoring me. My blood boiled.

So I left the room and left the ER to sit in the Medic Unit to write my report and cool down. As I gathered all my EKG strips to copy I wondered if I had overreacted about the patient. Maybe he wasn't really having a heart attack. Maybe I was wrong. Joe came out with supplies and said they had moved our patient to room 1. "Good." I said, finally they were taking him seriously.

When I was done with my report I went back inside to get the MD signature and give them a copy of the report. The ER was a buzz with activity, the secretary was yelling about the helicopter being 20 minutes out, the doctor looked stressed. I turned out that my patient was having a right sided myocardial infarction (aka: heart attack, MI for short). I was right about the heart attack.

*My point. Right-sided MI's are treated differently than regular MI's because of the decreased preload. If you give a regular MI Nitro, it opens up the vessels and helps. If you give it with a right sided MI, it opens up the vessels and bottoms out the preload and your patient goes down the tubes. Read: you can kill them. To counteract this effect you have to dump more fluid into the patient. Since I did not have an IV established, I would have been helpless to fix it. I easily could have killed him.

So why did my patient's blood pressure go up after the first dose and stay high after the second? I asked myself that. I asked a nurse that. I asked the MD that. The answer is the same: No idea, it shouldn't have happened, the BP should have dropped like a an Acme anvil. It is times like this that I am very grateful. I wondered all night why. Why was I so lucky? Was the big guy looking out for me? Or was he protecting my patient? Was it a mere coincidence? Or Heavenly Father intervening?

It is times like this that I am grateful for Heavenly Father. I don't know what happened that night but I know that when I am out there, messing with peoples lives, Heavenly Father has my back. I know that He is not going to keep me from pain. I know that it is my responsibility to do the best I can to be the best I can. But I also know that when it is beyond my control, Heavenly Father can intervene. And I am grateful for that.