It started off with a gentleman with a NSTEMI and sepsis of unknown origin. He went into shock. I was not sure whether it was cardiogenic or just purely sepsis. To complicate matter, he went into fast atril fibrillation and his BP dropped even further. Never have I seen a patient as blue as he was. He was both peripherally and centrally cyanosed.
The second patient was a patient with active variceal bleed. By the time I saw him, he already vomited like 1L of blood! The surgeon inserted a Sengstaken blakemore tube to stop him from bleeding. I remember being a medical student and reading about variceal bleed. As far as I could recall, Sengstaken is used during clinical emergency where there are no other means to stop the bleeding.....and this is normally RARE.
Anyway, me being me, I was panicking. I have no idea how to manage this tube. The surgeon who inserted it started to give me instructions about how to inflate and deflate the balloon...how often I should do them, how long I should leave the tube in..etc...
As he was speaking, nothing was registering in my brain. Everything sounded Greek to me. It was too much information in an emergency situation. Then I went into a phase where I could see his lips moving, but I could not hear anything (i know this is very sad). All that came into my mind was this patient needs to go to HDU because no one in the receiving unit would know how to manage the tube.
The poor man was actively retching and bringing up fresh red froth. He was also actively losing blood from his rectum. The surgeon was busy trying to maintain the balloon of the Sengstaken tube inflated. The nurses were suctioning his mouth. I was trying to get a better IV access in him. It was all abit chaotic at the endoscopy unit.
He was nearly in shock. His BP went to about 109 systolic, he was tachycardic at 176! The nurses wanted to go home because it was 5.30pm already. But there was no way there were going to transfer him back to the normal ward. He has to go to HDU. But the nurses insisted on leaving and they just moved back to the ward against my advice! sigh. What can I do. But this really annoyed me.
Imagine this. Say for example, if I was in the middle of trying to resuscitate a patient (just like what we were doing to the bleeding man), and it was 5pm, which is the time for me to go home, should I just leave and say, "Oh look, its 5 pm. I am going to go home. You guys can carry on resuscitating him." But have we doctors ever do that? A big and loud NO. But why do nurses get away with that?? This remains a mystery. We stayed on to work on him..until he is stable enough and we are happy that he is in the appropriate unit and has a proper management plan in place. (my apologies to any nurses reading this).
Back at the ward, the other nurses were giving me the stares. I felt guilty...but really, it was out of my control. Anyway, he eventually went to HDU...... like 2 hours later.
I felt so harassed. In the midst of all these events, I have the consultant surgeon on the other end of the phone telling me how ridiculous of us medics to leave a man with hepatic encephalopathy in HDU. To be honest, this patient had a GCS of 7 to start with...he obviously had picked up when the surgeons were there to visit the HDU. The HDU nurses were also on my back telling me to step this patient down. But I just didnt have the chance to do that because I was occupied with other sickies.
Then, when I went back to the ward, everyone seems to be looking for me. Imagine this. When I walked out from a particular room, one nurse, one houseman, one DVT nurse specialist, all decided to call my name in unison. I was being attacked at all angles.
Oh man...it was a crazy day. And I'm absolutely drained.
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