Highlights of the day

I'm not quite sure which was my personal highlight of the day, there are two close competitors - a case of post-partum thyreoiditis and my first pericardiocentesis. The latter was in the course of a resuscitation attempt on an elderly woman that skriehma took part in as well. He cheated his way out of ped's ER boredom by just pretending to have gotten "stuck" in ED1. Yeah .. whatever :) . The little old lady (who at least in my opinion never stood a chance) apparently lost breath sounds on the left (although they weren't really regularly checked, may as well have been a misplaced tube) after I stuck a needle through her diaphragm, pleura, maybe lung and pericardium, so skriehma got to stick two needle thoracostomies into her. I think I also broke at least two of her ribs during CPR. She curiously had PEA during most of the resuscitation and was shocked when she went into V-Fib, but eventually didn't make it. I don't think anyone ever expected her to though. I don't know any of her history, but she looked asthenic, may have had a consumating illness, maybe malignancy. There is a reason these people go into arrest - and after 30 minutes without adequate circulation it is not likely to have gotten better to the point where the heart suddenly decides to start going again. Unlike young people who stumble into a cardiac arrest, these people have used up all their reserves. Compensation mechanisms, for example to tolerate acidosis or hyperkalemia were running at maximum already before the arrest, the latter being the result of just these mechanisms failing. I'm not saying we shouldn't attempt to resuscitate these people. But I guess that's the reason why everyone including me thinks the chances of meaningful recovery are very slim.

The other highlight was a woman who was actually there for acute abdominal pain. Among her copious history were only two clues - delivery of a healthy boy three months ago and she noticed some hair loss four days ago. That seemed reason enough to add a TSH to the labs and bam! 15.59! Yay!