waiting room heart attack
patients can be confusing to staff. they can be confused themselves. their spouses can be confused by the patient. confusion is not a reason to be careless. such was the case of an older couple in their mid-70s who came in. the husband sat in a chair, and his wife walked over to the front counter. the man was about six feet tall and thin but not malnourished. the woman gently explained that she believed her husband had a heart attack last night. and off to the races we go. she explains he woke up in the middle of the night with severe chest pain lasting a few minutes. he would not let her call 911 and insisted on returning to sleep. she complied with his wish, and they came to us at noon.
NO TIME LIKE THE PRESENT
now perplexed and concerned as the woman explains the situation, i look at the man. upon a more prolonged observation, he's sweating and fidgeting. i look back to the woman and state i will get one of the doctors. walking to the back, i hear a thud, followed by a shriek. as i turn around, lo and behold, he's on the ground. complete syncope with eyes wide open, pupils dilated. it was his wife screaming. now i run to the back, 'we have a patient having a heart attack in the waiting room.' everyone leaps up and rushes to the front. the two doctors immediately go to the patient and attempt to wake him. as they lift to get him on a chair, he comes to.
WHEN THIS BABY HITS 217 BPM, YOU'RE GONNA SEE SOME SERIOUS...
A nasal cannula is placed at 3 lpm. Now fully alert and very agitated. 'I need air!' 'you're getting oxygen right now, sir.' 'I need to get outside; I need air.' we have placed a pulse oximeter on his finger while trying to keep him seated. The pulse reading is between 200 and 230 bpm. The cause for this is likely because he did have a heart attack last night. His heart's electrical output is distorted, and his rhythm is abnormal.
911 was already called and on the way at this point. An IV is placed in his arm, and an EKG is started while he's seated. At this point, his energy to try and get out of the office has faded. He was maliciously compliant now. The EKG shows precisely what was expected. stemi in v2. This means st elevated myocardial infarction or a severe kind of heart attack. His pulse rate is all over the place.
ROUND 3, FIGHT
Right before the ambulance arrives, his energy returns. He tries to get up from the chair, ripping the IV out of his arm. He tries to move toward the door, pulling the still-attached oxygen tank. His shirt opened, the oxygen tank hooked up, and he yelled. He looked like a Hector Salamanca meme. The doctors are trying to get him under control as he yells about needing air again. As he gets to the door, EMS arrives. 'ready to run out, are you?' the medic is now standing in the way of freedom. 'yeah, he had a stemi last night and is possibly having another now.' 'Well, you and I can ride to the freedom cath lab in my freedom wagon.' now being placed on the stretcher, his wife trying to calm him. still trying to argue and yell, the medic and emt ignore it as they strap him down.
now gone, I start to clean up the blood on the floor from the pulled IV. As I make my way backward from the door, following the blood trail, a puddle of urine awaits me where he is seated.A few weeks later, we got a letter thanking us, and he did have a stemi. He needed to be defibrillated to get his rate and rhythm under control. He had 4 near-total occlusions and received 4 stents. If you think you're having a heart attack, don't go to urgent care. They are not equipped to deal with such a severe condition and waste valuable time.
for more about heart attacks (don't think you're having one after reading) you can check out this resource: https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106