Buddy comes in the other day, 63 year-old guy, no previous history of anything, with crushing chest pain radiating down the left arm beginning 45 minutes previously, nausea, vomiting, pallor, diaphoresis, SOB, no BP and yeah, he’s having a big-ass inferior-posterior MI. No problem. We’ll just load up the TNK, give him some fluids and get him fixed up. And before we can get out the clot bag, he does this:
This is polymorphic ventricular tachycardia. This is not good: it means that in this context he’s probably going to code imminently. Even the patient is saying he’s going to die. And when your patient says this, you listen.
My hands actually shake as I draw up and push the TNK. Even steely-eyed, seen-it-all emergency nurses get frightened for their patients on occasion. Just don’t tell anyone.
Time is muscle, the saying goes, and door-to-needle time is six minutes. Ninety minutes and a few reperfusion arrhythmias later, his pain is resolved and his ECG is nearly normal.
It amazes me that if he had walked in only twenty years ago, he would have been dead, most likely. Streptokinase, the first thrombolytic drug, first came into general use in the early ’90s. (If you have ever hung streptokinase as a nurse, you are clearly dating yourself.)
Now we save lives with a five second bolus.