She wasn’t right.
In Observation the other night where we, well, observe patients: holds and the frequently admitted and such. Then EMS offloads a 68 year-old woman into Room 4, acutely SOB, restless, history of COPD and a long, long cardiac history, nonSTEMIs and stents and whatnot: so not surprising. Chest actually sounds okay, no peripheral edema. No chest pain now or earlier.
But she isn’t right. I mean her vitals are stable, and she’s much less SOB with O2. She’s obese and getting her comfortable on the emerg stretcher is a challenge but she even settles into an uneasy sleep. Yet something is wrong. Nothing I can put my finger on. The only other abnormal finding, apart from her shortness of breath, is her cold periphery: hands and feet are ice.
The virtue of being an old emergency nurse is that when you think you need to move a patient into the Resus Room, the charge tends to listen to you. So we moved her. There’s moaning and kvetching from the two Resus Room nurses who were patient-free, happily bored and watching Nurse Jackie on the Net. Why did you move her in here? She’s stable, isn’t she?
I think: I love you both dearly, but you’re being lazy as all hell.
But I say: “She’s not right.”
My colleagues shake their head. WTF, they’re thinking. I don’t care. I give report then go to break, hoping to doze off for a few while listening to endless gabble on CP 24. I drift off, dreaming I think, of a warm beach and the sound of water . . . then a rude awakening.
“Code Blue, Code Blue, Emergency. Code Blue, Code Blue, Emergency.”
Shit. I know it’s her.
I run into the Resus Room. Compressions have started. What happened?
“She went into an idioventricular, then PEA.”
Compressions halt for moment for a pulse check. No pulse. We all stare at the monitor. Slow idioventricular, then nothing. Asystole. Compressions again, another round of drugs, then it’s all over.
Trop comes back at 64.8.
She wasn’t right.