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Amari Mendez | Day One. 3pm. Pediatric Emergency Room.

"When the paramedics first brought her in, I did a quick visual assessment,"

remembers Elizabeth Haines, D.O., the attending physician on call when Amari was brought to the Pediatric Emergency Room. "I saw that she was very sweaty but awake on the bed. The paramedics told me that she had just been in basketball practice, so I thought the sweat was from that. I was just coming on duty and was reviewing patient records, and when I came back to her bed, no more than five minutes later, her condition had significantly deteriorated. She was noticeably confused and her blood pressure was so low, 70/40, that I thought it was an error and ran it again.

When it came back with a blinking underscore, I knew that she was in big trouble. Her diastolic blood pressure was so low, that the machine couldn't even register it.

"She was able to talk but was becoming increasingly agitated, which is often the body's way of crying for help. She was very short of breath, her blood pressure was sinking, her oxygenation was way down and she was becoming more and more confused. I was instantly assessing the possibilities for what this might indicate in a healthy 16 year old. Could it be a poison? She said she hadn't eaten anything unusual or taken any medications. Could it be
her heart? She said she had no known heart conditions.But maybe this was an unknown heart condition.

"I immediately ordered an electrocardiogram (EKG), a test that records the electrical activity of the heart, and called for an echocardiogram (ECHO), an ultrasound that creates a moving image of the heart. As Gerardo Chiricolo, M.D., chief of NYM's Division of Point-of-Care Ultrasound, was entering the room with the ultrasound machine, the results of the EKG were coming out. He and I looked at the results and said to each other, 'there's no way an EKG like this came from a girl that young.' I ran it again-the same. It was the worst heart attack I had ever seen in a patient of that age." As Dr. Saleh grabbed the EKG result from her hand and sprinted to get Terrence Sacchi, M.D., chief of cardiology, Dr. Chiricolo performed the echocardiogram. The anterior and lateral walls of her heart were not contracting, and fluid was quickly collecting in the lungs. Amari was having a massive heart attack.

They instantly called a STEMI (ST-segment Elevation Myocardial Infarction) code to alert the cardiac catheterization team that there was a patient in cardiac arrest who needed immediate treatment.

Amari's condition was continuing to deteriorate quickly. "She could no longer speak," remembers Dr. Haines, "and without speech, there was no way to assess the quality of her
airway opening. We needed to intubate her. When we inserted the tubing into her airway, so much excess liquid had built up in her lungs due to the weakened beating of her heart that
liquid literally squirted out of her mouth from her lungs. We needed to let the water drain out of her before we could introduce the oxygen."

The cardiac catheterization team arrived and whisked her off to the Cardiac Catherization Laboratory.

Read more about emergency services at NYM.

Read the whole story in its original form, and more, in NYM's Annual Report to the Community 2011-2012.

Day One. 6pm. Cardiac Catheterization Laboratory.