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Saturday, September 1, 2012

The case of the upside-down woman in the emergency room

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A 7-foot-man walked into an emergency room dangling a 5-foot-woman by her feet. She told the staff that if she was upright, she'd pass out. She was only able to maintain consciousness while upside down. No, this isn't a joke. This is a true story that her attending physician, cardiac electrophysiologist Louis F. Janeira, recounts in Discover Magazine. Spoiler: The tip of her newly-installed pacemaker had become disconnected from her heart muscle. When she was upside down, the lead reconnected and stimulated her heart. From Discover:
“You’ll need to go back to surgery to reattach the lead,” I said to Mary. “Let’s page your electrophysiologist stat.” I looked at Jason and sighed. “Meanwhile, keep her upside down.” We inserted an iv in Mary’s arm and hooked her up to an external pacing device. But pacing her heart through her chest wall gave her severe discomfort and was not a good option, even in the short term. Moreover, it turned out that Mary’s slow beat did not respond at all to medications, including intravenous epinephrine. So she was quickly transported to the electrophysiology laboratory, dangling by her ankles, carried by the only man around with enough strength to do it. And my ER shift continued.
The next day I was back on duty. As I came out of a room after examining a small child with a fever, I heard a familiar voice behind me.
“Dr. Janeira, it’s me, Mary. I’m all fixed up.”

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