Sunday, January 30, 2011

Fly Me To The Moon

Ok, funny story about work now that it's over- it was not funny at the time.  

Last night I had a patient whose heart rate was dipping into the 30s... not good.  A heart cannot perfuse a little old man's body with a heart rate of 32.  During the night I'd checked on him a number of times and each time he was his typical self - talkative, cooperative, oriented to himself, time and place.  

The song of my night was "Fly me to the Moon" by 'ol Blue Eyes, Frank Sinatra.  Let me tell you why--

Well!  At 5:40, I go to check on him, draw his morning labs and get a set of vital signs (blood pressure, oxygen saturation, temperature, etc).  He was definitely not himself this time.  He was resistant, moaning, groaning, wheezing a little bit, and he even reached his arm up to tickle me in the armpit - weird!  The longer I had him awake the more odd he was becoming.  After asking him a few questions to see what was going on, he made me nervous.  

Me: "Mr. So-and-so, where are we?"  
Patient: "The moon." (dead serious)
Me:  No, we are not on the moon.  Don't play.  Where are we?
Pt: "We're on the moon"

Oh boy.  I paged the doctor (again- the first time he said, ok, I'll come look at the telemetry monitor-the monitor that shows his heart rate and rhythm - my thought is he should come look at the patient too!).  He comes to see the patient, we get another set of vital signs, his blood sugar is 90 (a-ok), his blood pressure was a little low but he had been running low since being admitted, his physical exam was normal (other than his wheezing), all that was really off was his mental status - uh oh.  If your mental status changes, you're in trouble.

We gave him a medication called Atropine which works to increase the heart rate.  We also gave him some IV fluids over a quick amount of time and sent him for a CT scan of his brain.  Shortly after getting the Atropine he perked up a bit but the most astounding part was after he returned from CT.  He was totally back to himself!  He was no longer wheezing, heart rate came up to the low 50s, he was awake, talkative, cooperative, funny, he knew exactly what room we were in and chuckled when I told him that earlier he'd said we were on the moon!

It's amazing what some Atropine and normal saline can do!

Fly me to the moon... let me pay among the stars...

I'm glad I could bring this man back to earth, he wasn't ready to start seeing what spring is like from Jupiter and Mars (at least not on my watch!).

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