Hal Adams, RN: Lucinda, I'm going to need you to step in while I get Dr. Smith. Eddie's complaining of new onset chest pain, his BP is 90/65, heart rate 110, he looks pale and diaphoretic.
Peg's getting his 12 lead. He has his oxygen. He's having an MI. Get him on a monitor and start an IV. I'll be back with Dr. Smith in 2 minutes.
Lucinda Tyler, RN: Oh no, poor Eddie. Has he had anything for pain?
Hal: No, that's something you can take care of.
Hal: Dr. Smith, I have Eddie Thomas in Room 6. A 56-year-old with congestive heart failure, multiple ED visits.
Dr. Bart Smith: Hold on. Yeah, 40 milligrams of Lasix I-V, O2. I'll see him as soon as I get these dispo's done, gotta clear some rooms or we will be back on divert. I'm going to have to call you back.
Hal: Dr. Smith, I'm concerned. Eddie isn't presenting with his usual heart failure. He has substernal chest tightness radiating to the jaw. He looks pale and diaphoretic, BP's 90/65 verified with manual cuff, pulse is 110.
We have him on 02. We're getting a 12 lead, starting a line. I think he may be having an MI. We need you to see him now.
Dr. Smith: Based on what you've said, it sounds like it may be an MI. I'm on my way. Room 8, did you say?
Dr. Smith: Okay, Room 6.
Peg Ryan: Here's his electrocardiogram.
Dr. Smith: Hmm, this looks like it could be an acute MI.
All right, everybody, let's huddle up before we go in, so we know what we need to do.
Karen Wright, RN: I've got the 4 Liters O2 by nasal canula, and 2 baby aspirins. He's hypotensive, so maybe we should drop the nitro. He's already on the monitor.
Dr. Smith: Right, Good catch, Karen. Hold the nitro. Where are his cardiac labs?
Karen: His labs are pending. We should have those in 15 minutes.
Dr. Smith: Let's prepare to get him to the cath lab immediately.
Hal: I'll call the cath lab to confirm.
Dr. Smith: All right, let's get in there.
Dr. Smith: Eddie, you're having chest pain, you said?
Eddie Thomas: (laboring somewhat)
Dr. Smith: Eddie, this is different from your usual heart failure. I'm worried you're having a heart attack. A lot of things are going to happen over the next few minutes, then I promise we'll have a chance to talk.
Hal: The chest x-ray's here and the cath team confirmed that they can take Eddie in 5 minutes. Dr. Martin's on line 3 for you.
Dr. Smith: I'll be right back.
Dr. Bob Martin: Okay, Bart. Is this your idea of putting me on a diet? Because every time I put food in my mouth I've got a new ER case.
Dr. Smith: No, just trying to keep you busy.
It's actually Hal that made a good catch on this one.
Dr. Martin: Tell me more.
Dr. Smith: This is Eddie Thomas, a 56-year-old gentleman with viral cardiomyopathy and frequent episodes of congestive heart failure. We know him well.
Today he came in with an acute anterior MI and early cardiogenic shock. We do have his new and old electrocardiogram.
He described the pain as "ripping" and his history is one of viral cardiomyopathy, not coronary artery disease, so I'd consider squirting his chest to be certain there's no dissection.
He's had aspirin and heparin, we're starting integrillin. There's no beta-blockade or nitroglycerin on board on account for his hypotension. His labs are drawn and pending.
I'm going to sign off. Hal will be here to make sure you've got everything you need.
Dr. Martin: Okay, Bart. You have a recurring heart failure patient with new onset atypical chest pain. Electrocardiogram findings are consistent with an anterior acute MI, aspirin but no nitro, and labs pending. I got it from here.
Dr. Smith: Hey, Hal, good job with Eddie earlier today. Our communication was precise and we got him the necessary attention quickly. Good job.