Anytime a nurse asks you this question, run and hide, immediately.  The question is asked because a) it’s a woman with pelvic pain, and you’re the only one on b) the patient is a child/friend/coworker and the nurse thinks you’ll treat them nicely or c) the patient is very, very sick, and the nurse doesn’t trust anyone else to take care of them. 

Now for options a & b, I’m happy to chip in, but not when there are five other patients who still havn’t been seen.  Everyone here is basically pleasant, and all of us, men included, have been trained to do pelvic exams.  Option C, however, is an exception.  Run into the room as fast as possible because you might get a chance to save a life. 

This time, it was option C.  I walked briskly into the cardiac room, and a woman with an ashen face was sitting bolt upright, half-on & half-off the bed, pursed lipped breathing.  I tried to talk to her.  She would take about five breaths then say one word.  I had to choose my questions carefully so that her one word answers would be helpful.  “Are you having pain?”  Puff, puff, puff, puff, puff, “no”, puff, puff…etc

So with history not helping, an ashen patient apparently short of breath, the answers are quick and simple.  Shotgun approach to SOB.  Nebulizers & Lasix.  BIPAP machine.  Stat portable chest.  Her lungs were a whiteout. No fever, sudden onset.  She had ROPE.  Rapid Onset Pulmonary Edema.  We gave her sublingual nitroglycerin to offload the fluid in her lungs, a touch of morphine.  The bipap seemed to do the trick.  She looked more comfortable.  Spoke several words at a time that I couldn’t understand under the mask and noise of the machine.  I carefully watched her blood pressure as I asked how she felt about a “breathing tube” if needed.  She agreed if neccesary.  I still didn’t know if she’d turn the corner or not.

As soon as the respiratory therapist left, she ripped the mask off and shouted, “Get it Off! Get it Off!”  While it made me more comfortable to see it on her, she was obviously getting better if she could shout like that!  I left it off.  We finally got the catheter in her bladder since she could tolerate laying back a bit, and she put out almost 500 ml right away.  Soon, she was sitting comfortable on a nasal canula chatting it up with her daughter.  She had definately turned the corner for the best. 

It wasn’t until afterwards that I realized I felt completely comfortable directing her care and anticipating the next step.  I think if she hadn’t had rapid intervention (if an intern or off service resident had picked up the chart?) she could have easily crashed and coded right in the ED.