The patient lying in Springfield Hospital’s emergency department was diabetic and in his 40s. He had an accelerated heart rate and falling blood pressure. He told Dr. George Parsons that he felt like he was dying.
Diabetic ketoacidosis is indeed a life-threatening condition that constitutes a medical emergency. Luckily, treatment is fairly simple: fluids, electrolytes and insulin. Parsons expected his patient’s condition to improve quickly. But when 20 minutes passed with no change, Parsons was puzzled.
The patient didn’t have chest pain, didn’t smoke, didn’t have a personal or family history of heart disease, and was fairly young. Parsons decided to ultrasound his heart anyway. What made his brain jump from diabetes complications to cardiac issues? “I really don’t know, except that, as an emergency medicine physician, my brain is trained to jump—and fast,” he says.
The ultrasound showed that the patient had an enlarged right ventricle, the part of the heart that feeds blood to the lungs. A CAT scan revealed a blood clot in the lungs. “It was life-threatening, and we had to treat it fast,” Parsons says. “The patient was already deteriorating, and the clot could’ve led to his respiration being blocked, which meant that he would stop breathing and die.”
By the time TPA was ordered to unblock the clog, the patient needed help breathing and was in critical condition. It was up to his wife to consent to the treatment. “She was a mess, and understandably so,” Parsons says. “I explained the situation to her several times,
and I also had to tell her that waiting was not an option.”
She approved the lifesaving treatment, and four days later, the clot had dissolved. “He still had diabetes,” says Parsons. “I couldn’t cure
him of that.”