Sunday, September 27, 2009
Had an interesting patient today. Presented to the Ed responsive only to pain, pupils pinpoint and nonreactive. Was found by friends this AM, last known well time more than 24 hours ago. All BP, HR, RR, AP, Temp are wnl, CBG was normal. CT and EKG was normal. Lungs were diminished and pulse ox 92% on room air. Was vomiting. I pulled the ET tray "just in case," 1st year resident took the hint and we protected his airway. 20 minutes later his BP dropped like a rock and we could only get 43 systolic with a doppler. Since he is well known to us, we had admin narcan upon his arrival, with no response. All lab values were wnl, yet he was unresponsive, and now his BP was in the crapper. Hooked up rapid infuser and 2 boluses had no effect. Pulled out dopamine with the hope 1st year would get that hint. After he did not, I went to the ER doc and got order for dopamine, which in long run did not help, but at-least I got the ED doc to take over the case. We went to levophed, which got pressure up to 80/30. Still a crappy pressure in my book. As it stands right now, he is in ICU and they are still attempting to figure out what the heck is wrong with him.