The BIG 45

You MIGHT be a red neck if you walk out on a cardiac cath to go watch a NASCAR race on local cable. this patient has had an extensive cardiac history with open heart surgery with 5 count 'em FIVE STENTS ! This patient is quite adamant about leaving to watch this race. Pt signs out and leaves AMA despite a cardiac attending and fellow BEGGING him to stay.

It can be only assumed that said pt watched the NASCAR race soon afterwards. Seeing this first hand I have to say that this little scene was UNREAL!!!

Pt Left hospital AMA never saw this person again!

Fourty Four

Pt who is a mid-30's male is found unresponsive at local recreation center. Bystanders call 911 while others begin chest compressions. While waiting on ambulance arrive by standers attach AED to this unresponsive seemingly healthy male. The AED orders "NO SHOCK" no shock is given and  bystanders continue chest compressions.

Ambulance crew arrives (along with a fire engine a supervisor and a few police officers) pt is scooped up and placed into ambulance. Then the pt is assessed further by EMS crew. Pt is found to have a pulse with a GCS of 3 as reported by crew pt is breathing on his own. this patient is transported to us at BCH.

When the ambulance gets to the hospital (a very short trip from said rec center) the pt now has a GCS of 10. As pt comes into the critical care area of the ER the patient becomes more and more alert to the point of by the time we get him on the monitor we find out that the patient is deaf. When he does not want to talk to us any more he has another "syncopal" episode.

No one knows ASL in the ER. BCH has many many resources so in rolls a computer on wheels with a web cam on it. We dial up the ASL interpreter who pops right up on the screen and sees a room full of people around a patient who is now "unresponsive" the ASL interpreter is unaware her mike is on and the volume is on full blast on our end and she says:

"HOLY CRAP"

The room erupts in laughter.

The pt. arouses on his own again and begins signing with the interpreter. It begins a very circular conversation which frustrated the hell out of everyone. The patient was a poor historian. The only real complaint we get is the patient is having chest pain. Which figures because bystanders were doing chest compressions on him for a few minutes before the EMS response. Trust me if the AED did not stop the bystanders from shocking him he woulda gotten a 360 joules wake up call.

The patient was rapidly moved out of the critical care area into a regular room.  Never did find out why he passed out and was unresponsive. With intermittent episodes of responsiveness and unresponsiveness who knows what was going on. The patient of course got the million dollar work up. What can you do with these situations?

At least the system worked seemingly flawlessly and kudos to the bystanders:



Soon more mysteries of modern ER care in the dynamic urban environment will be revealed. I am just an old Crusty ER Tech trying to make it to the end of shift.