Things have been hopping at the clinic. I can’t count the number of ambulances we’ve seen come through in the past 2 ½ days. Well, that’s not true, there’s only one ambulance, it just came a lot. The patients are brought to the clinic first for evaluation/stabilization before being taken to the hospital in
An 18 yo was brought in because of severe orthostatic hypotension. His BP was almost undetectable when he sat up. He had been outdoors camping over the weekend and we assumed he was just dehydrated. So we started two IVs and pumped fluids into him but, after two bags, he was still hypotensive. As a matter of fact, he was cyanotic when he sat up. His ECG and labs were pretty normal so we sent him on to the hospital for an echo and heard nothing more about it before I left for the evening.
This morning during rounds we checked the computer before seeing him and got some pretty distressing news. He had an ejection fraction of <10% style=""> The cardiologist said he had never seen a case this bad in someone this young.
So giving him so much fluid (5 liters by the time he got to the hospital) was exactly the wrong thing to do. They spent all night in ICU diuresing him. The ARNP who saw him at the clinic was pretty distressed that she did the wrong thing but I don’t think she did.
So we started the day having to explain the problem to the kid and his mom. I can’t believe how tactfully the doctor presented such a dire case. Anybody know where I can buy some of this kind of tact?
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