Pathology

I promised myself I'd limit the number of medical posts.  Here's my first.

This is our emergency room - 4 beds in the hall outside the female ward.  In the picture you can see (from left to right) a suction machine that doesn't work, a defibrillator (the yellow thing - this is what you see on medical scenes in movies when they yell "CLEAR" and you hear a 'thump' as they shock the patient), a very nice, functional anaesthesia monitor (in back) and a barely working oxygen concentrator (the blue thing).  We ran out of oxygen tanks last night, which is why the concentrators were in use today.

The pathology - illnesses - I've seen take my breath away.  In the last 24 hours alone we've admitted 3 patients in cardiogenic shock (that's a gnat's whisker this side of full cardiac arrest) - one died, one got better, and one ... we'll see.

********** warning - medical terminology below - not for the faint of heart **********

This afternoon I saw a young (35yo) woman with a 15 yr history of heart problems.  When I met her, she was breathing 40 times a minutes, had a heart rate of 160 bpm and an undetectable blood pressure.  Her exam was consistent with cardiogenic shock.  An ECG showed rapid atrial fibrillation and I pulled the ultrasound machine in and did an echocardiogram: she had severe mitral stenosis (from rheumatic fever) and a dilated cardiomyopathy with an ejection fraction of 15% (normal = 55%).  What she needed, paradoxically, was to slow her heart down, to allow it to fill a little better between beats.  I gave her a little IV valium so she wouldn't remember what I did next, then pulled out that yellow machine in the photo and said, "CLEAR!".   Thump.   Then she had a blood pressure.  We'll see.

If you would pray for her, her first initial is R.