Doc in the Box

Wal Mart. You can do everything there. The Wal Mart in our response area sells the normal Wal Mart stuff, plus groceries, and automotive repair services. Inside, there is a pharmacy, an eyeglass store, two restaurants, a bank, a photo studio and a Walk in Medical Clinic.

How poorly do you have to do in medical school to be the Wal Mart doctor? We responded to this "Doctor's" office three times yesterday. One of these visits was telling.

A man here was on vacation, and sitting near the pool eating is vegetarian submarine sandwich. Less than thirty minutes later, he developed shortness of breath, a tickle in his throat, and a rash known as urticaria. He complained that he "felt bad." What does the family do? Call 911? Rush him to the hospital? No... They took him to Wal Mart, in the process driving past two fire stations and a hospital.

When he arrived, the Doctor gave him 50mg Benedryl, 1mg Epinephrine, and 125mg of solumedrol. When all of this failed to work, she called 911. When our heroes arrived, we noted that she had given everything except tagamet, so we talked about starting a tagamet infusion (300mg over 10 minutes). The Doctor told us that she would rather we did not, because the patient had been seen a month ago by his doctor back home for chest pain, and that he would need cardiac monitoring before we gave any drugs.

Uhhh- she doesn't even have a cardiac monitor (we do) and she gave him epinephrine, which was the correct thing to do. However, epi has far more cardiac effect than tagamet does. Yes, there are rare instances of arrhythmias and hypotension with tagamet, but then again epi is to be used with caution in patients with a history of hear disease due to the increased myocardial oxygen demand that epi is sure to cause. The fact that the patient was orthostatically hypotensive was more of a concern to me than an anginal episode of unknown origin a month ago.

We got him in the truck, did a 12 lead, IV, oxygen, tagamet, and went down the road. He had no known allergies, so eating a sandwich will be an adventure for him in the future. Heck, it may not have even been the sandwich. We DO have a lot of biting insects here.