Sunday, April 25, 2004
Fight or Fright
Doctor, could you come and see this patient in resusc, she's just arrived.
But I'm doing something el... oh all right then. (I'm nice that way, sometimes)
hello there, how are you doing. Oh dear. you don't look very well. Short of breath huh, sudden onset.
patient gasps desperately with resp rate 40 and SaO2 82%. Crackling +++ audible even over the nebs the nurse applied on arrival.
oh. a sickie. Big deal, been there, done that. Probably CCF. look at her swollen calves +++.
A - gasping for breath, speaking clearly
B - SaO2 82% on 15L, Crackles throughout both fields with mild wheeze. RR 40
C - b/p 190/100 HR 80
CXR stat, iv access stat, 40 frusemide.
ABG taken. dum dee dum. twiddle thumbs waiting for ABG. nurse could you get me some diamorph and a bit more 40 mg frusemide please.
patient still sliding slowly. SaO2 80%
PO2 6. (corrected, 5)
SIX.
PCO2 6. (corrected, 6)
SIX!!
quick another 80 mg fruse.
ug. no response.
Oh. f*ck. SaO2 77%. Despite 160 mg frusemide.
CXR florid pulmonary oedema
panic. blase-ness melts away. Sudden premonitions of a cardiorespiratory arrest in resusc. On my shift. With me being the doctor in charge at the moment... groan.
Zip out of resusc to find the resusc nurse - need help right now. Need CPAP and ITU now please. The medical SHO is standing nearby. It's the pretty blonde one... but who gives a s*it - at the moment my patient is sliding, and fast.
I show her the ABG and she mouths a most unladylike expletive, before telling me to do pretty much everything I've just done, as well as suggest GTN infusion. (doh. I hadn't got that far before I zipped out for help...)
anyhow, after a lot of headless chickens running about (GTN? We've run out! in A&E. groan) the ITU reg comes along to see her.
and of course the second he starts talking to her the frusemide kicks in, delayed action 10 min later and her sats come up to 80. 85. 94%
Phew.
Funny how when it happens it so doesn't feel like ER, innit?
Funny also how you spend nights as a med student on call waiting patiently for moments of excitement which never arrive. Yet when you're an on-call doctor you can never get away from it all.
Doctor, could you come and see this patient in resusc, she's just arrived.
But I'm doing something el... oh all right then. (I'm nice that way, sometimes)
hello there, how are you doing. Oh dear. you don't look very well. Short of breath huh, sudden onset.
patient gasps desperately with resp rate 40 and SaO2 82%. Crackling +++ audible even over the nebs the nurse applied on arrival.
oh. a sickie. Big deal, been there, done that. Probably CCF. look at her swollen calves +++.
A - gasping for breath, speaking clearly
B - SaO2 82% on 15L, Crackles throughout both fields with mild wheeze. RR 40
C - b/p 190/100 HR 80
CXR stat, iv access stat, 40 frusemide.
ABG taken. dum dee dum. twiddle thumbs waiting for ABG. nurse could you get me some diamorph and a bit more 40 mg frusemide please.
patient still sliding slowly. SaO2 80%
PO2 6. (corrected, 5)
SIX.
PCO2 6. (corrected, 6)
SIX!!
quick another 80 mg fruse.
ug. no response.
Oh. f*ck. SaO2 77%. Despite 160 mg frusemide.
CXR florid pulmonary oedema
panic. blase-ness melts away. Sudden premonitions of a cardiorespiratory arrest in resusc. On my shift. With me being the doctor in charge at the moment... groan.
Zip out of resusc to find the resusc nurse - need help right now. Need CPAP and ITU now please. The medical SHO is standing nearby. It's the pretty blonde one... but who gives a s*it - at the moment my patient is sliding, and fast.
I show her the ABG and she mouths a most unladylike expletive, before telling me to do pretty much everything I've just done, as well as suggest GTN infusion. (doh. I hadn't got that far before I zipped out for help...)
anyhow, after a lot of headless chickens running about (GTN? We've run out! in A&E. groan) the ITU reg comes along to see her.
and of course the second he starts talking to her the frusemide kicks in, delayed action 10 min later and her sats come up to 80. 85. 94%
Phew.
Funny how when it happens it so doesn't feel like ER, innit?
Funny also how you spend nights as a med student on call waiting patiently for moments of excitement which never arrive. Yet when you're an on-call doctor you can never get away from it all.
