I had a patient at 2:30 this morning. She was complaining of chest pain that this 56 year old woman described as “a set of Vise-grips crushing my chest.” She also complained of shortness of breath and nausea. All of this started as she was working her night shift job on an assembly line making 3D glasses. Her husband died in February, after a long battle with cancer. Her 12 lead was unremarkable, she was in a sinus rhythm, and her vitals were: HR 78, BP 89/62, RR 18 SaO2 94% on room air. She has pale lips, and rates the pain as a 7/10. Lungs are clear.
The first thing we did was place her in Trendelenberg, and gave her some O2 at 2 liters, then I started an IV in her right antecubital vein. I gave her 325mg of aspirin, and off we went to the hospital. I couldn’t get that blood pressure stable, and it kept dropping. After we had given 800ml of saline, her blood pressure was now 68/44. I started a dopamine drip. She stated that she weighed 136 pounds, so I started her off at 12 drops per minute.
We arrived at the hospital to see the nurses rolling their eyes, and they immediately disconnected the dopamine. THEN they took a BP and got 63/40. Instead of treating her, they retook the BP. 8 times. They moved the cuff to the other arm (the one with the IV), so they started a second IV. Then they moved to the right thigh, and finally to the left thigh, where they got a BP of 100/60. That is the BP they chose to believe.
Now you don’t have to have a medical education to understand that if you take a BP 8 times, and get the same result 7 of those 8 times, that the 8th time is probably NOT the correct one. However, in this case, the 8th BP was the one that allowed the nurse to get away with not doing anything.
Sometimes I get so exasperated with the incompetent and lazy people we have in the medical field.