So this guy (a 72-year-old male) checks in with a chief complaint of chest pain one evening. Nurse noted that he had taken Cialis recently. From chart scanning, I just assumed this was another case of ED-induced ED visit. However, this was a misdirection from assumption. Here’s what really happened – he reported:

“Doc, I was sitting in my den watching TV and suddenly got this chest pain. I asked my wife to go and bring me my blood pressure machine. Saw my pressure was 176 over 100. I never get pressure that high so I remembered that Cialis can lower a person’s pressure, so I took one. The pain finally went away and now I feel better.”

He was indeed pain free, his BP was now 106/72 and his EKG was normal. And in case you were wondering, he had no active circulatory shunting. After explaining to him the usual rule out procedure requiring in-patient stay, I went over to the nurses station and carefully crafted my orders, which included:

• Keep monitored
• Avoid orthostatic position change
• Absolutely no nitro in any form
• Male nurse if at all possible

Some of you may recall that short life of MAST pneumatic trousers for shock management many ATLS versions ago. I would have asked the nurses about MAST undershorts but most of them would think MAST was some new competitor to Fruit of the Loom.

This man’s creative use of Cialis got me thinking about creativity and some interesting quotes:

“Anyone who has never made a mistake has never tried anything new.”– Albert Einstein. [Commentary: Certain mistakes prevent any subsequent mistakes – forever and ever.]

“Do not follow where the path may lead. Go instead where there is no path and leave a trail.”– Ralph Waldo Emerson. [Commentary: But get off the trail and call your doctor if the trail remains straight after four hours.]

“I never perfected an invention that I did not think about in terms of the service it might give others… I find out what the world needs, then I proceed to invent.”– Thomas Edison. [Commentary: Wow – could he be on to a new antihypertensive that allows one to perform under pressure?]

This month’s article on perinatal disaster management supplements a previous article from 2011. When that article went to press, the chart I developed could not be included, so now we offer an updated version with the chart and a narrative covering new information published since 2011.