Our patient, c/c “chest pain”, was sinus tach and sprinkling PVCs like confetti.
We’re applying oxygen, he’s got some morphine on board, and we’re just opening the nitro when he codes, just as we get to the hospital.
We hit the ED doors running, pushing, bagging.
“Code! We need a room!”
“Room 4!” The charge is right on top of things.
We roll into room four. “On Three! onetwothree!”
Our patient is onto the bed, CPR resumes, bagging resumes.
The attending physician is a new guy, I’ve never seen him before.
“What’s the story?”
“68 year old male, chest pain for 1 day, took two aspirin 325 at home and called 911, sinus tach with PVCs on the way in, coded three minutes ago.”
“Full code” Really? Didn’t he see us working the guy? But okay.
The attending says to the nurse, “Get RT down here, let’s tube this guy,”
To us: “Stop CPR. Let’s get a rhythm check.”
We stop CPR. The monitor shows little tremors, minor quakes on the surface of the heart. Some life left, it seems.
“Fine VFib,” the attending says. “Charge and shock”
A nurse grabs paddles, puts her hand on the dial. “What do you want to charge to?” she asks.
The attending seems to consider it.
“Oh, I think he just need about tree-fiddy.”
“I’m sorry?” the nurse said.
“He need about tree-fiddy.”
Well, it was about then that we noticed the attending was a six-story tall crustacean from the Paleolithic era.
“Dammit, monster!” I said. “We ain’t chargin’ to no tree-fiddy! In this ED we *work* our patients! Ain’t no protocol for tree-fiddy! Monophasic, bi-phasic, ain’t none of them call for tree-fiddy!”