Friday, April 9, 2010
Every month I spend one day covering the psychiatric ER. Last month, I came onto my shift with an elderly patient who had not yet been evaluated. He had allegedly overdosed on Vicodin. Let's call him Jimmy Vikes. His drug screen was positive for tricyclics, acetaminophen, and opiates. He got Narcan in the ER then they punted him to psych. He was sound asleep when I came in, so I figured I would let him sleep while I discharged all the drunks on a Saturday morning.
While I was interviewing a 50-year old manic guy who assaulted his 80-year old parents, the psych tech came over and said "Jimmy Vikes stopped snoring." So I excused myself from interviewing the rambling, abusive jobless manic dude. Jimmy Vics had a thready pulse, about once every 10 seconds. No respirations. I felt my sphincter tighten. I haven't done a code since I was an intern 2 years ago. I told the nurse to call the stat team and I started BLS. They showed up after what seemed like an eternity (our ICU/ER is literally across the street from the psych ER). They intubated Mr. Vikes and took him to ICU. I expected the worst.
A week later, I found out that Jimmy V was discharged from ICU to home. He was alert and at his baseline. A google search indicates that the survival rate of in-hospital CPR is 18%. It's gotta be less than that on a psych unit. My good friend ER doc often references the book "The House of God." Its author describes patients who will not die, no matter what happens. They are called GOMERs. They will not die, despite insane degrees of illness and heroic interventions.
I tell this story not to brag about my life-saving prowess. I am the last doctor that you want doing BLS on you or your loved ones. I am telling you this so that you're aware that another Gomer lives and walks among you. That Gomer better be happy for psych techs with good hearing.
Posted by SerenityNow at 9:59 PM