“Notification!” Brenda shouted as she hung up the red phone. “Eighty-year-old, altered mental status, no palpable blood pressure. Three minutes out.”
While nurses gathered IV equipment and an EKG machine, two paramedics rolled in a stretcher bearing a small, moaning, barely conscious Asian woman.
“Couldn’t get a blood pressure,” the chief medic said, panting. “Pulse 30 on arrival.” That meant her ventricle had stopped responding to her pacemaker, so they jolted her heart with a shot of atropine, which bumped her heart rate to 60.
"Her medical history is renal failure, dialysis three times a week, hypertension, and a history of stroke,” the medic added. “Son says she woke up confused, saying her legs hurt. Couldn’t walk. Fine the night before. We gave her D-50 [a glucose solution that reverses hypoglycemia]. Didn’t help.”
Thin and wiry, Mrs. Chee looked awful. Brenda hooked her up to the EKG machine. Out came one scary electrocardiogram. Instead of intermittent, tightly spaced spikes and valleys, there were broad, sickening drops followed by abrupt peaks—a paper roller coaster. When the queasiness in my own stomach settled, I said: “This is hyperkalemia [high potassium]—it has to be. She needs calcium now.”
