Tuesday, March 26, 2019

Doctors and nurses, what was the most unusual patient code situation you've seen? Did the patient survive?

As an ER scribe, I followed physicians on all calls and recorded the details of physical exam, treatment, diagnosis, etc. One evening we had a lady in her late 50’s come in via ambulance unconscious. Per the history, the patient had been tested at home and found to be hyperglycemic (high blood sugar) so the daughter had given her around 10 units of insulin and called an ambulance (pt was unresponsive). The ambulance arrived and took their own blood sugar reading, which still showed high, so they gave more insulin. Upon arrival in the ER the EMTs were unsure why the patient had not yet regained consciousness, and their blood glucose monitor still showed her as having an elevated reading. Our doctors took their own glucose reading after the hand-off, and the glucose was 8. EIGHT. A normal glucose is 80–120. Low is 40–60. 8 will kill you. Why wasn’t this lady dead? She was on an LVAD. LVAD= Left Ventricular Assist Device. This machine basically pumped her blood for her. In a healthy human a glucose of 8 would have stopped the heart (no fuel) and damaged the brain (no fuel or oxygen). This woman, because she was waiting for a transplant and couldn’t use her own heart, was able to survive because the machine didn’t care about her glucose levels (oxygen kept flowing). 50 grams of Glucose were given via the carotid artery, and she regained consciousness a few minutes later. The doctors mentioned something about the EMTs needing to calibrate their glucose machine… (One of the three scariest things I saw during those 6 months as a scribe.

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