Tuesday, February 19, 2013

Dr. Sherlock Holmes

Round about midnight, the paramedics deliver a senior citizen suffering from "general weakness." No surprise.
Her resting pulse is 40. Big surprise.
Oh, and no, she doesn't regularly run marathons or bike in the Tour De France.

As I and my co-workers get her hooked up, IV'ed, and labs drawn, 12-lead EKG done, etc., ER Doc starts pawing through the pillowcase of meds the paramedics have helpfully scooped off the nightstand and delivered along with the somewhat lethargic grandmother on the gurney.

So when the husband arrives a couple of minutes later, Doc does a quick interview with him, since he's much more with it than his other half.

When he comes out of the room, Doc hands me one of the bottles, and says "Send one of these tabs to the pharmacy to identify the medication stat."
I have a tech run it down right then, and call the PharmD. on duty, and give him a heads-up and the 20 second run-down on the patient.

My patient is stable, just in profound bradycardia. As long as we don't try to get her up and walk her around, no worries for the moment.

Doc warns to get a dopamine drip ready, which I do, but her pressure stays stable in the low normal range, so we hold off for now.

Within a few minutes of my tech's return, pharmacist calls back, and when the doc picks up I stay on the other extension.

"The med is verapamil, 240 mg."

Except the fresh Wrong-Aid Pharmacy label on the bottle says it's 40mg.
The geniuses at the local drugstore have had grandma unknowingly dosing herself with a 6-day dose of her BP med every 24 hours for the last week, and her calcium channel has been really blocked. Like another couple of days and she might've not woken up one night.

So I give the nice lady a really annoying NG tube, which fortunately spares her the nasty taste of the charcoal I'm going to pump down it, and the ER doc admits her to ICU.

Medically speaking, I almost never recommend that anyone should consider a lawsuit, but in briefly explaining the situation to Nice Little Old Man, I suggest to him that in all likelihood some legal advice wouldn't go amiss, and that their everyday pharmacy should expect to be picking up the tab for tonight's little pharmaceutical misadventure.

And that they might want to think about getting their prescriptions filled somewhere else, at least for awhile.

So I ask what the husband said, and Doc tells me hubby was absolutely certain none of the wife's meds had changed anytime recently except the one bottle (out of about twenty in the case), and he'd pointed it out to us.

Nice going to both docs. Sherlock frickin' Holmes in action.

Doctor                 1
Death                  0

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