Wednesday, November 30, 2005
White as a sheep, pale as a goat
It struck me this morning how vasovagal syncope mimics hypovolaemia... pallor, sweatiness, tachycardia, hypotension...
One of our postops decided to spring a leak last night, and was producing a fair amount of blood in her wound drain every hour.
It wasn't fast enough to make me do more than sit up and take notice initially, and run through the preflight checklist of tests to do now, and things to be ready for in the future. (and call for senior support)
A short while later as I was finally savouring a moment's peace, the phone rang and a nurse politely informed me that our patient was slightly hypotensive at 70 systolic.
That's when you switch from surgical everything-is-under-control mode into A&E oh-shit mode, and sprint over to your patient. (Or in my case, limp)
Sure enough, she's drowsy, pale, sweaty, tachycardic and hypotensive.
Alarm bells are ringing in my head (but not on the monitor since, like every self-respecting doctor the world over the first thing i've done on arrival is to press the "suspend alarms" button) as I lower the bed down flat and press the call button for a nurse (since naturally, none of them are around despite their taking the time out to telephone me about it...). She recovers a tiny bit with the bed flat.
Her mucous membranes are pale too, which gives me a moment's pause. Perhaps we (ie the bosses) are wrong about how much - or rather, little - the wound is really draining. The wound site is also rather swollen...
A&E mode, on. (in an adult it takes for a loss of about 30% your blood volume to cause hypotension)
O2 please.
run the saline fast, and get me
iv gela, 500 mls, stat (why the heck don't we have any on our ward??)
and a large bore cannula, and blood taking stuff, and an ECG, and call the blood bank for 2 units of blood, go-go-go.
She pinks up and wakes up, and the rest of the evening is spent on tenterhooks expecting something to go wrong again any momet...
Much later, when the lab results come back I find I've over-reacted by far since her pre transfusion Hb is low - but not as low as I'd thought. No harm done to the patient, but I'm kicking myself for ruining the rest of my evening by asking the nurses to call me every 1 hour with her vital signs and wound drainage, hence ensuring the world's greatest sleep-deprivation hangover the next moning.
It must have been a syncopal episode.... but dang it, usually someone who's sick doesn't waste time or effort fainting!
One of our postops decided to spring a leak last night, and was producing a fair amount of blood in her wound drain every hour.
It wasn't fast enough to make me do more than sit up and take notice initially, and run through the preflight checklist of tests to do now, and things to be ready for in the future. (and call for senior support)
A short while later as I was finally savouring a moment's peace, the phone rang and a nurse politely informed me that our patient was slightly hypotensive at 70 systolic.
That's when you switch from surgical everything-is-under-control mode into A&E oh-shit mode, and sprint over to your patient. (Or in my case, limp)
Sure enough, she's drowsy, pale, sweaty, tachycardic and hypotensive.
Alarm bells are ringing in my head (but not on the monitor since, like every self-respecting doctor the world over the first thing i've done on arrival is to press the "suspend alarms" button) as I lower the bed down flat and press the call button for a nurse (since naturally, none of them are around despite their taking the time out to telephone me about it...). She recovers a tiny bit with the bed flat.
Her mucous membranes are pale too, which gives me a moment's pause. Perhaps we (ie the bosses) are wrong about how much - or rather, little - the wound is really draining. The wound site is also rather swollen...
A&E mode, on. (in an adult it takes for a loss of about 30% your blood volume to cause hypotension)
O2 please.
run the saline fast, and get me
iv gela, 500 mls, stat (why the heck don't we have any on our ward??)
and a large bore cannula, and blood taking stuff, and an ECG, and call the blood bank for 2 units of blood, go-go-go.
She pinks up and wakes up, and the rest of the evening is spent on tenterhooks expecting something to go wrong again any momet...
Much later, when the lab results come back I find I've over-reacted by far since her pre transfusion Hb is low - but not as low as I'd thought. No harm done to the patient, but I'm kicking myself for ruining the rest of my evening by asking the nurses to call me every 1 hour with her vital signs and wound drainage, hence ensuring the world's greatest sleep-deprivation hangover the next moning.
It must have been a syncopal episode.... but dang it, usually someone who's sick doesn't waste time or effort fainting!
