I was working on a completely different blogpost tonight when I stumbled into one of those amazing real life events on Twitter, when there is a genuine urgency to the communication and a story unfolds.
Being Twitter, this was fairly rapid fire, and terse. The gaps in the drama are filled in by imagination. The entire event unfolded in 45 minutes. It began like this.
You can watch the drama unfold in this Twitter slideshow:
Saving Lives in Real Time
Evening in an unnamed hospital in an unknown location somewhere in North America. Anonymous doctor has a patient in hypertensive crisis that is not responding to standard treatment. He sends a brief comment to Twitter. Other doctors respond and discuss. A nurse chimes in, then a medical librarian. During discussion, patient finally begins to respond to treatment. He’ll be fine.
beRt_MD: Not able to control hypertensive crisis with nitro infusion. Adding nicardepine. I’ve got only 1 peripheral IV.
– RichmondDoc: @beRt_MD nitroprusside?
beRt_MD: @RichmondDoc nitroglycerine. Has CHF too. Trying to venodilate. Already got dialyzed and still sbp > 200
– BurbDoc: @RichmondDoc @beRt_MD at that point I think I would need nitroprusside myself!
– RichmondDoc: @beRt_MD Yowza.
pfanderson: Trying to save lives in real time Twittering, going on NOW. Conversation between @BeRt_MD @BurbDoc @RichmondDoc #hcsm
beRt_MD: @BurbDoc @RichmondDoc Was already on Nipride. Didn’t work.
beRt_MD: @BurbDoc @RichmondDoc Already on CCB, clonidine, hydralazine, ACEI, BB, and terazosin. All maxed dose.
– KinetiCycle: @beRt_MD add hydralazine to your list
– beRt_MD: @KinetiCycle already on it.
– BurbDoc: @beRt_MD @RichmondDoc Intracranial process?
– beRt_MD: @BurbDoc @RichmondDoc No. Neuro intact. CT neg
pfanderson: @beRt_MD Anything useful in here? >Resistant hypertension and hypertensive crises: Dx eval/Tx. http://www.ncbi.nlm.nih.gov/pubmed/20937447
pfanderson: @beRt_MD I’m med librn. Reading article. Labetalol, Fenoldopam mesylate, Diazoxide, Verapamil also options. p. 644 Acelajado & Calhoun
– beRt_MD: @pfanderson No but thankful for the link. Recs are to use parenteral agents like Nipride, nitro, nicardepine, esmolol which we are using.
– pfanderson: @beRt_MD Good luck! Very tricky w/ comorbid CHF.
– beRt_MD: @pfanderson Thanks. BP is coming down.🙂
– pfanderson: @beRt_MD Oh, thank goodness! So glad to hear. Now, the long wait. Thank you for good news!
UPDATE (An hour after initial post)
Later clarifications and responses to this post from the “cast” of the drama. My thanks and appreciation to them all, for exhibiting their passion, curiosity, caring and sharing; for creating a story worth sharing.
beRt_MD: Want to clear I was not soliciting advise. Just reporting difficulty w patient & answering ?s
beRt_MD: Otherwise I’m ok with blog. It seemed so much more exciting in ur blog.🙂
beRt_MD: U do highlight an interesting potential with social media. Ability 2 collaborate in RT.
beRt_MD: Need to address privacy & medical legal issues but huge potential for benefit across many fields.