Eight hours into a hectic 12-hour solo-coverage day shift in our community hospital ER, I finally got the chance for a lunch break. I hustled to the hospital’s food court, bought two slices of pepperoni pizza to go, and hurried back to the ER lounge where I popped open a Diet Coke, took a big swig, then dove into the pizza.
The head nurse appeared at the door just as I finished the first slice. “Chest pain in One.” I took another quick slug of Diet Coke, closed the pizza box, and hurried from the lounge.
We reserved Bed One, closest to the resuscitation room, for evaluation of patients with acute chest pain. It got a lot of use. Today’s tenant was a sixty-two-year-old pudgy fellow in obvious distress. The nurse spoke into my ear. “Abrupt onset of crushing pain in his mid-chest while mowing the lawn. Wife drove him here.”
Pellets of sweat dotted the man’s forehead. Wide, frightened eyes surveyed the surroundings while nurses and techs started an IV, positioned a green-plastic nasal cannula to deliver oxygen through his nostrils, and pasted EKG leads to his chest and extremities. I shook his hand. Calloused yellow-stained fingers, sallow skin reeking of stale tobacco. A pack of Marlboros peeked out from his shirt pocket.
“How long since the pain started?”
“Maybe an hour.”
“Ever had it before?”
“Never like this.” His breaths came in shallow, rapid puffs.
A tech handed me the completed EKG. As expected. “ST elevation in the precordial leads. Call a STEMI. Start the protocol.”
The unequivocal EKG, along with the acute symptoms, age, obesity, and smoker status, confirmed ST-segment elevation myocardial infarction, or STEMI; an evolving but reversible heart attack. Sudden blockage in a coronary artery had interrupted blood flow to a region of the man’s heart. The muscle—myocardium—was dying, but not yet dead. Our axiom: Time is muscle. Muscle is life.
We had a narrow time-window in which to restore circulation to the compromised heart muscle before it became a hunk of inert flab; or worse, the damage spread and killed our patient. “Time is muscle” meant urgent heart catheterization for percutaneous transluminal coronary angioplasty (PTCA) to open the occluded artery with a tiny balloon threaded to the heart via catheter from the femoral artery in the groin. Our rule: “Door to balloon” in less than thirty minutes.
“Code STEMI, ER. Code STEMI, ER.” That announcement over the PA system summoned a specialized team to the patient. Meanwhile, the ER staff administered chewable aspirin (as a blood thinner), morphine by IV (to relieve pain and anxiety and reduce stress on the heart), and IV heparin (another blood thinner for the catheterization).
I stepped aside for the clamorous arrival of the STEMI team, led by our head of cardiology.
I passed her the EKG. “Textbook.”
She skimmed the tracing, nodded, and approached the patient. “Sir, I’m a cardiologist. You are having a heart attack, but we will do all we can to reverse it. We will take you upstairs for heart catheterization where we expect to remove a clot in one of your coronary arteries. Then we will place a stent to keep the artery open. Understand?”
The man nodded, a mask of terror frozen on his face.
The cardiologist gestured to her team. “Go.”
In an instant, a gaggle of six attendants wheeled the bed with the patient, attached IVs, oxygen tank, and heart monitor out of the room.
Their clamorous egress soon left me standing alone in the abandoned space. I looked at the timer on the wall. Twenty-two minutes from the patient’s arrival.
Time is life.
I returned to the lounge to find the remaining pizza slice waiting for me. I took a long look at the enticing, oily, cheesy gooiness of it, then tossed it in the trash. I opened the refrigerator and retrieved an apple I’d left a few shifts ago.
(Note: STEMI EKG image from “Top 5 MI ECG Patterns You Must Know.”)