Tuesday, July 06, 2004
The Good, The Bad and The Beautiful
Good :
2.4 km down to 11:30 (yay me.)
Bad :
maximum runtime down from 20:00 to 15:00 (bugger)
Thought for the day :
What makes a woman beautiful?
*****
Heart Stopping
I put someone into VF today.
While working on my own patient in resusc, I was drawn aside to listen to someone's chest because he was "a bit short of breath".
Hello sir, blahblahblah.
The chap looks remarkably well, pink and rosy, sats 100% and smiles as he chats. normal obs.
I auscultate his chest and it's completely clear although he's complaining of some difficulty breathing.
The nurse hands me an arterial gas syringe so I obediently perform it.
"Owwowwowww!" etc. (Well, I did tell you it was really going to hurt.)
Phew. Glad that's done with. Whilst I'm staring vacantly at his heart monitor, the trace nightmarishly turns into that dreaded pattern that makes a junior doctor's heart leap into his throat.
"Urrrrk." The guy says to me, turning a peculiar shade of white and rolling his eyes rather unfetchingly at me.
I slap my hand on... no pulse.
Mind blank.
I hear someone's voice say "no pulse, prepare to shock". Oh. It's mine.
The charge nurse chucks some gel pads at me and tells me to put them on. I'm frozen to the spot, and in the brief moment I hesitate another nurse (suddenly there's so many of them! In just a fraction of a second!) reaches forwards but I snap out of it and stick the pads on smoothly.
There's mention of precordial thumping which I promptly do. Nothing happens. VF (that's Vee Eff for you ER watchers) still on the monitor.
Stand clear, is everyone clear? Everyone steps back.
pause. Bugger it's not charging. Oh. someone's set it to 30 instead. Could you... okay charging. Shocking.
Pause.
Rhythm change. The hand (mine!) slaps back on. No pulse.
I'm... not really with it. I look around and begin to pull myself together.
Right. Airway... someone's putting a guedell in
Breathing - ambu bag in nurses hand. that's all right then.
Circulation (shouldn't I be calling this out loud?) - nobody's doing CPR, so I jump onto him and start compressions.
"Right, prepare the drugs please" again that voice. Oh yeah it's mine, again.
Rhythm check. He's back.
Phew!
The two registrars appear and ask me if I'm running this. I curtly say no, I was just walking by. I don't want to be running this one... I wasn't ready, in my mind. It caught me off guard, and all I want to do right now is sit down. My knees have gone all wobbly for some reason.
Bugger. I think I almost killed this guy with my ABG. Well, I know I didn't, but it feels like it.
Right now, at home, I... think I'll go to the gym later, and try out that free taekwondo class. For some reason, I really need to hit something.
My fist still stings a little from that precordial thump. laughs.
*****
Slipping Away
Did I mention today's been a REALLY rubbish day? Another hour and a half was spent desperately trying to save a man acutely short of breath making horrible bubbly noises with his breathing, with severe bilateral pitting oedema from his ankles to his thighs.
After lots of antibiotics, a few nebs (no wheeze though) and some frusemide with very little effect, and a gradually worsening blood gas (severe hypoxaemia, severe hypercapnia, severe acidosis)
despite many attempts at different oxygen concentrations (which also revealed a very high potassium prompting immediate gluconate and insulin / dextrose) I discover he's also in acute renal failure as well (creat 600), which I'd already suspected with the potassium of 7.9.
There's a certain look, that just clues you in. Well, one learns to recognise it. It's the look of someone who has death standing over his shoulder.
I sigh as I knock off, and give the man's daughter a sympathetic look. She probably already knows what's going to happen, decked up in her nurse's uniform.
I really need to hit something. I miss fencing...
2.4 km down to 11:30 (yay me.)
Bad :
maximum runtime down from 20:00 to 15:00 (bugger)
Thought for the day :
What makes a woman beautiful?
*****
Heart Stopping
I put someone into VF today.
While working on my own patient in resusc, I was drawn aside to listen to someone's chest because he was "a bit short of breath".
Hello sir, blahblahblah.
The chap looks remarkably well, pink and rosy, sats 100% and smiles as he chats. normal obs.
I auscultate his chest and it's completely clear although he's complaining of some difficulty breathing.
The nurse hands me an arterial gas syringe so I obediently perform it.
"Owwowwowww!" etc. (Well, I did tell you it was really going to hurt.)
Phew. Glad that's done with. Whilst I'm staring vacantly at his heart monitor, the trace nightmarishly turns into that dreaded pattern that makes a junior doctor's heart leap into his throat.
"Urrrrk." The guy says to me, turning a peculiar shade of white and rolling his eyes rather unfetchingly at me.
I slap my hand on... no pulse.
Mind blank.
I hear someone's voice say "no pulse, prepare to shock". Oh. It's mine.
The charge nurse chucks some gel pads at me and tells me to put them on. I'm frozen to the spot, and in the brief moment I hesitate another nurse (suddenly there's so many of them! In just a fraction of a second!) reaches forwards but I snap out of it and stick the pads on smoothly.
There's mention of precordial thumping which I promptly do. Nothing happens. VF (that's Vee Eff for you ER watchers) still on the monitor.
Stand clear, is everyone clear? Everyone steps back.
pause. Bugger it's not charging. Oh. someone's set it to 30 instead. Could you... okay charging. Shocking.
Pause.
Rhythm change. The hand (mine!) slaps back on. No pulse.
I'm... not really with it. I look around and begin to pull myself together.
Right. Airway... someone's putting a guedell in
Breathing - ambu bag in nurses hand. that's all right then.
Circulation (shouldn't I be calling this out loud?) - nobody's doing CPR, so I jump onto him and start compressions.
"Right, prepare the drugs please" again that voice. Oh yeah it's mine, again.
Rhythm check. He's back.
Phew!
The two registrars appear and ask me if I'm running this. I curtly say no, I was just walking by. I don't want to be running this one... I wasn't ready, in my mind. It caught me off guard, and all I want to do right now is sit down. My knees have gone all wobbly for some reason.
Bugger. I think I almost killed this guy with my ABG. Well, I know I didn't, but it feels like it.
Right now, at home, I... think I'll go to the gym later, and try out that free taekwondo class. For some reason, I really need to hit something.
My fist still stings a little from that precordial thump. laughs.
*****
Slipping Away
Did I mention today's been a REALLY rubbish day? Another hour and a half was spent desperately trying to save a man acutely short of breath making horrible bubbly noises with his breathing, with severe bilateral pitting oedema from his ankles to his thighs.
After lots of antibiotics, a few nebs (no wheeze though) and some frusemide with very little effect, and a gradually worsening blood gas (severe hypoxaemia, severe hypercapnia, severe acidosis)
despite many attempts at different oxygen concentrations (which also revealed a very high potassium prompting immediate gluconate and insulin / dextrose) I discover he's also in acute renal failure as well (creat 600), which I'd already suspected with the potassium of 7.9.
There's a certain look, that just clues you in. Well, one learns to recognise it. It's the look of someone who has death standing over his shoulder.
I sigh as I knock off, and give the man's daughter a sympathetic look. She probably already knows what's going to happen, decked up in her nurse's uniform.
I really need to hit something. I miss fencing...
