Of EMed (3)

my, are the posts coming in fast and furious.

resus was pretty busy on friday night. had an ami in one panel and then five minutes later another was wheeled in, much to the dismay of the doctors involved. one thing i've noticed about ami patients is that some of them don't seem to realise the severity of the situation. ami is one of those "run of the mill" emergency cases where the management and protocols are like reflexes to the medical staff so if you get treated early, you'll get a "run of the mill" outcome - a discharge after three days. before the days of pci (percutaneous coronary intervention ie balloons, stents, etc) and thrombolytic therapy, i doubt the survival rate of a heart attack was as high as it is now.

so it is a bit surprising that some patients either refuse treatment or request a delay in it, citing reasons such as "an important meeting tomorrow." it can be one of two things - denial, or the sad state of our lives in the present world, where losing our jobs strikes greater fear in us than losing our lives. each time i've had to resist the urge to shake the patient and say,"sir! if you don't get treated now, there will be NO tomorrow!"

almost all will eventually consent to treatment, but i've read the casenotes of one who went through four ami without agreeing to intervention. amazing.

had a bit of fun in the p2 area when a woman was wheeled in. she's apparently a frequent visitor of our hotel, and knows all the medical staff. she had all those buddhist prayer beads and some round contraption that chimed, and she went from nurse to doctor to medical student reading palms. she broke into song several times ("three, four, buckle my shoe" and the ever popular 上海滩) and made interesting phone calls ("darling are you coming to pick me up?" and then suddenly "what do you mean, mm? i'm not staying!") even more hilarious was her reaction to a moaning, confused patient - a loud and emphatic "diam!!" which of course did nothing to stop him from moaning.

i wonder who will come through the doors tonight?