Saturday, June 6, 2009

Back to basics, again...and again

Swam at Nitro with David, Tom, Jeanne, and Anita. Clint coached. Steve wore scuba gear and shot underwater video of us. Crikey, mate! Watch while I wrestle a giant age grouper! The pool was set up long course.

500 swim
6 x 50 kick @ :55 with fins
500 pull
Main set, 2x through:
400 @ 7:00, went 5:48 amd 5:40
2 x 200 @ 3:30, held 2:47s
4 x 100 @ 1:45, held 1:21-1:22
100 easy

Didn't get alot of sleep last night as I was called in at 2:00 for a STEMI transfer from Georgetown. Once again, the computer's interpretation of the ECG was incorrect, but identifying a patient as a "Code STEMI" by the transferring physician sets in motion a cascade of events that engulfs everyone in its path. I interrupted the process in the ER long enough to take a history and complete a physical exam, in the process discovering that the patient had abdominal but not chest pain and was tender in her right upper quadrant. An ultrasound confirmed the presence of gallstones and an inflamed gallbladder (aka cholecystitis). A CT scan, apparently ordered to exclude an aortic dissection (which would have been a second, unrelated diagnosis), confirmed the presence of cholecystitis. I received a call from the ER physician later that morning to let me know that the cardiac enzymes, which he'd sent to rule out a myocardial infarction (aka heart attack, a third unrelated diagnosis for those of you keeping score at home) were elevated (falsely, in my mind). Now the general surgeon declared that he could not operate on a patient who was suffering a myocardial infarction (which she was not). So later in the day I took her to the cath lab where we found that her coronary arteries were entirely normal. She is awaiting gallbladder surgery.

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