She came to the clinic for acupuncture for her stubborn back pain, on a scale of 8 out 10. Her tongue was pale, with a bright red tip, and thin white coat. While taking her pulses I noticed a small bruise over the heart pulse position on her left wrist. The pulse was knotted, intermittently intermittent. I asked her about the bruise. She said she went to ER a few days earlier, with chest pain, and, because they couldn't do an inguinal angiogram, they retried from her left wrist.
In the process she had an allergic reaction to the dye. And her blood pressure dropped to 70/25.
Hearing this I had our nurse take the patient's blood pressure. It was 96/66. She also mentioned that her cardiologist had put her on a new prescription, and had given her his cell phone number to call him at the first sign of trouble. At that point I walked across the hall and asked our Attending Pain Physician if he would consult with her, and possibly tweak her pain meds, since I was not comfortable doing acupuncture. I told him, based on a classmate of mine who found a heart patient dead on his table, following a potty break, I told him I was guided by the rule, "who ever touches the patient last, before a major health breakdown, is it."
After I triaged her to the Pain Physician, I later asked him how things went. He reported that during the consult she mentioned that while she was in ER her heart stopped and they had to give her a shot to restart her heart. Bad odds. High risk. Not a good acupuncture candidate.