Saturday night, a patient came in by EMS, rolling around on stretcher, moaning and crying. Complaining of left flank pain for 6 hours. EMS said he was beeing a jerk, uncooperative. Went in to assess him, acting like he had a kidney stone so started an IV, fluids and asked the doc for pain meds. His oxygen level was low so I started him on oxygen, his heart rate was high, thought it was from the pain and deydration so opened up the IV fluids to rehydrate. He got pain meds, then went to CT. The CT tech came running back with the patient; patient had effusions to bilateral lungs (fluid in the lungs or below the lungs). No official read from the radiologist so started a second IV, gave more oxygen and more pain medications.
When the official read came back, results were a ruptured esophagus! The effusions were caused by the fluid and food that the patient had eaten that went through the hole and settled under his lungs. 100% fatal without immediate surgery! 25% fatality even with surgery. We did not have the capability at my hospital! So we were on the phone for emergency transport, getting the cardio-thorasic surgeon to the hospital we were sending the patient to. We were able to get him to the OR at Moses Cone. Heard later that he was unresponsive when they got him on the table. Found out last night the he made it through the surery!!! YEAH! This is why I do what I do. Every now and then, what I do with my team in the emergency truely saves a life. If we had waited, the patient would most likely have died. We work together, work hard and move onto the next patient.