It's not asthma

I know I said I would not do medical rants. But here it is.  Yesterday started out as a very shit day.  In the little "non urgent" jobs book, somebody had written: overnight patient tachycardic (fast heart rate), dropped sats (not getting enough oxygen), SOB (short of breath) - please R/V (review).  Little alarm bells started ringing in my head.  In their defence, they had gotten the night resident to review the patient.....  He listened to her chest, the patient had a wheeze, and he gave the patient ventolin (at just under 100 years of age, he didn't seem to disturbed that someone would develop "asthma" for the first time).  At 6.30am, nobody is at their best.  I understand that.  I am sure I have made a lot of bad calls when I'm in that state.  However it left quite a big mess for me to clean up this morning.
 
You see I interpreted things a little differently.  I interpreted a sudden onset of SOB, decreased sats (85%), increased blood pressure in a patient with no history of asthma who was just under 100 years of age and had dementia so was not likely to verbalise chest pain, as more likely to be an MI (heart attack).  So I went and saw the patient: clammy, wheeze and creps in lungs, not complaining of chest pain.  And thought - MI and pulmonary oedema (fluid on lungs). Which meant I had to run around doing bunches of stuff. Getting ECGs, bloods, chest xrays, trying to convince nurses the patient needed 6L of O2, trying to put a drip in to give the patient frusemide, writing up aspirin, trying to get a med reg to RV her, contacting the family to see if they want the patient NFR (not for resus). And yes, indeed, troponin 0.12. The patient has had an MI. Yes the patients chest xray even after frusemide showed pulmonary oedema. In a not surprising event, at just under 100 years of age the patient had not developed new onset of asthma. Once the patient had the frusemide, the patient started to look a lot better, and was even eating lunch when I came and saw the patient later. Oh, and despite the patients comorbidities and the patients age, and four conversations via phone - the family want full active resuscitation (me saying "are you sure you want us to jump on the patient's chest to do compressions, cracking the patient's ribs, which will probably pierce the patient's lungs that will require the patient having a tube in the patient's chest and cause the patient a lot of pain for the few days it might prolong the patient's life for before the patient still dies anyway?" did not deter them). It is absolutely their choice, but I have to wonder who they're doing it for. Their decision is supposed to reflect what they think the patient would want in that situation, not their own desires and confusion.

Anyway, because the resident has been away on the other ward, my afternoon was taken up with me doing admissions there, while on my own ward, for some reason the nurses all handed over that I had gone home for the afternoon. They were very surprised when I came by to check on the sick patient and to take a 12 hour troponin.

No more aged care... I'm back to Obs and gyn next week.