Clustery call

Last week I had, for once, a very sick patient. His wife called us for his shortness of breath.
When I saw him, he was sitting up leaning over his knees, pale as a ghost, awake, and breathing, but barely. Within a minute of our arrival, he stopped breathing altogether and started to go sideways onto the couch. Thankfully there were three of us there to drag him unceremoniously off the couch and onto the floor. It was now we could see he had a trach. I was so glad to see it, as given this patients size, he would not have been easy to tube.
The only problem with the trach, as we discovered, was that it was not compliant with our BVM which is absolutely ridiculous, and meant that we could not easily ventilate him. We ended up capping the trach and bagging him the old fashioned way. This obviously worked as he began to be combative as his brain got more oxygen. By then I had an IV in him that was threatening to be pulled out, and he had gone into runs of V-Tach (a deadly heart rhythm) twice. He had self converted both times, and although I knew it was due to lack of oxygen, we gave him some amiodarone for good measure.
It was a struggle to get him out of his house, and I feel that if he had been any further from the door, the story may have had a different ending.
Of course, it was raining outside so I had to replace is defib pads once we got in the ambulance. Luckily, I didn't have to use them. I tested his blood sugar which was over 600 which is equivalent to having maple syrup run through your veins.
We got him successfully to the hospital and he was looking a lot better, even conscious after a few more minutes of oxygenation. I was pretty excited as it was one of those rare times when I can actually say that if they had waited to call or we had taken three more minutes to get there, he would have died.

I was about to leave the hospital when all the alarms in his room went off. So we jogged in there and he was again in V-Tach. For the third time I put defib pads on him, but again he converted.
I hope this never happens to me, as I think it would be very concerning for a patient if everyone ran into your room, looked between you and your heart monitor with worried faces and kept asking if you were okay.
Well, he was okay, he tolerated these runs pretty well and was conscious the whole time. He was pumped full of different medications and later was transferred to a fancier hospital.





There is a lot wrong with this EKG.

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