Exertional fatigue (new onset)

[Just Plain Ruff]

my next note to myself after seeing 3rd degree and then 2nd degree that I'm not gonna stand and pivot him again, too many times I've done that on a patient and they sometimes seem to crash.

I'm gonna be doing most of the lifting of this patient myself.

Case in point, patient with symptomatic brady at 40 lying on the floor. chest pain and all that.

I get a IV, o2, monitor and give her .5 of atropine and hr increases for about 2 minutes, gave 2nd dose of atropine - another increase for 2 mins and then back to 40.

We sat her up, helped her to her feet(cramped cramped living room), and put her on the cot, her rate is now at about 20 and long pauses.

Lay her flat and she increases to 40 again.

Put the pacer pads on.

Transport to ER because birds aren't flying it's stormy out.

Get to the ER and the nurses insist on making her move on her own. BIG FREAKING MISTAKE HUGE HUGE HUGE

She brady's down to 20 and then flat line. She told me right before she coded "I don't think we should have done that"

That was the last thing that she ever said to me or anyone else.

This happened a long time ago but any patient with chest pain and bradycardia gets picked up by me and my partner and doesn't participate in any movement of themselves while I am taking care of them.

Use this as a lesson to be learned

[akroeze]

My lesson learned is that orthostatic vitals make people worse. Twice in the past month I've done orthostatic v/s and they have plummeted and not come back above 90!