Tuesday, April 06, 2004

5:00 am

Chatting with my MO friend in resus, we're suddenly interrupted by 2 health attendants pushing a patient from the triage area.

"Heart attack!" they shout, running over to the nearest available trolley. The guy is a big fella, pale and diaphoretic, slumped in the wheelchair.
"Any ECG?" we ask.
"Not done yet."
Silent exchange of looks as my friend and I wonder how accurate this "heart attack" statement is.

Turns out to be right on the money. Florid ST elevations anterolateral leads. BP systolic 89, patient responsive but mental state slightly altered by pain and hypotension.
Me: Sir, when did your chest pain start?
Patient: I dunno.
Me: Can you just give us a rough idea? Before or after midnight? 3am? 4am?
Patient: I dunno.

Quick conversation with his son.
"Errr, I don't know either. I got home at 4am, and he was already complaining of pain."

Cardiologist gets a page from me. Nice chap, but needs further details.
Me: I can't get any answer regarding when the pain started. I really tried, but he keeps telling me he doesn't know. He just says he woke up with the pain.
CVM: So he was okay before he slept. Find out what time he went to bed.
I ask as instructed.
Patient: I dunno.
Me: Was it before or after midnight?
Patient: I dunno.
Me: Didn't you look at the clock?
Patient: No.
Me: How about dinner? Were you okay then?
Patient: Yes.
Me: Okay, so what time did you have dinner?
Patient: I dunno.

I'm getting exasperated, but the cardiologist asks me to see if the patient's wife is around. Turns out she just arrived.
Wife: He ate at around 8pm, but I don't know when he went to bed because I slept first. ( She doesn't know what time his chest pain started either. )
CVM: Sounds like the onset is definitely less than 12 hours. All right, start r-TPA.
I speak to the patient's family first, who understand the risks involved and tell me to go ahead. I start running through the checklist as I explain to the guy. He doesn't really seem to care.
Patient: ( sits up ) Just give me the form to sign.
Me: You do understand what I just said, right?
Patient: Mmm-ummm... ( scribbles his name then flops back down onto the pillow )

Finally get to sit down an hour later. Patient safely tucked away in the MICU, and all I can think about is how hungry I am.

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