Welcome to Save of the Month! where each month we recognize a resident who went above and beyond to make a great save in the ED. Nominations are solicited from the faculty each block and we pick one (or sometimes two!) resident for recognition and embarrassment on this blog.
This edition’s Save of the Month goes to a terrific duo of residents. . . Drs. Billy Caputo and Eugene Kang! (I know they already won this honor but there’s no rule against repeating)
Here’s the story . . .
A very old dude came in with lethargy to UHB. Dr. Kang came to me with the the patient’s ECG and simply said the patient looked “sick”. The ECG had a bizarrely wide complex rhythm and when I told Kang about the patient’s recent admission for “renal problem”, he immediately considered hyperkalemia. He transferred the patient to the resuscitation room (at some consternation of the triage nurse). We had difficulty getting venous access – both peripheral and central – as the patient had significant intravascular volume depletion. Albuterol 20mg via nebulizer was given. Dr. Caputo then placed a brachial venous catheter with sonographic guidance and medications for hyperkalemia were finally given. Subsequent elation was quickly tempered by Caputo’s reference to a quote from “Pulp Fiction” (see The Wolf). An ultrasound of the bladder revealed distention but also an echogenic fluid level. Catheterization yielded what appeared to be 800ml of spoiled milk – similar to what one might see in Dr. Valesky’s refrigerator. Initial K returned at 8.3, crn 17, lact 4.1. 2.5 liters of normal saline were given rapidly but the lone peripheral access then 
failed. Contralateral brachial venous access was obtained and broad antibiosis and further fluids were given. Multiple attempts at IJ access failed, and Caputo and Kang finally placed an axillary vein triple lumen central line using both sonographic guidance and a modified “cut-down” technique. With further resuscitation and treatment, the patient’s mental status improved, ECG rhythm improved, K was reduced to 5.6, and crn from 17 to 12.
Congrats gentlemen!
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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