Tuesday, November 27, 2007

A Night of Two Halves

Busy Busy Busy.

Interesting. The department was, once again, heaving when I came on last night. Patients queuing to get off ambulances, and mustachioed doctors groaning under the workload. A full hospital. I note that when this happened to the Norfolk and Norwich, they declared a 'code black' and made the news...

Two incidents stand out for me. Firstly, there was the delightful lady who seemed to think that because she had taken an overdose, she could behave as she wished. She took the opportunity to subject everyone within reach to a torrent of the foulest, most bilious abuse imaginable. She topped off her performance with a fine array of spitting. A command performance.

Having determined that her overdose required little in the way of acute management, we disabused her of her ideas about entitlement by having her arrested.

Next I once again had the pleasure of double bunking in resus. In a sort of homage to Steve Martin in the 'Man with Two Brains' I simultaneously treated 3 teens from an RTC. Single vehicle vs tree; they were all in reasonable shape, which was more than could be said for the car.

After this, the night fairly flew by. By six, all was quiet... for about 3 seconds. It was then that the patient handed over to me, with the fateful words "He'll be fine, you won't need to do anything", started fitting.

The fit subsided fairly promptly, but the spreading petechial rash, and frank blood in his catheter bag did not ease our minds. To compound matters, just as the possibility of meningococcaemia was rearing its ugly head, a young woman 2 weeks post chemo was wheeled in.

Now, for those of you unsure, chemotherapy, for all its many benefits, rogers your immune system good and proper. So, once that's happened, one becomes subject to all sorts of previously harmless infections. The hospital often beckons. But next to a patient teaming with meningococcus is low on the list of places you wanna be.

A bit of juggling later, we had achieved isolation. Of sorts. But the department had backed up sufficiently to give the morning crew the impression that we'd done buggerall over night.

Ah well.

On a lighter note, I was able to review some CT scans. These were of the cervical spine of an elderly patient. It was this patient whose condition I was afraid I had misdiagnosed. Had missed.

The CT supported my original diagnosis.

This is good for a number of reasons.

1) The patient does not have a broken neck
2)The patient does not have a spinal injury
3)I didn't miss a spinal fracture.

The altruistic Shroom is clearly glad that this means the patient is well.

(But it's quite nice to know I didn't make a mistake, for the sake of not having made a mistake...)


The Platypus said...

You had an overdose arrested? That's awesome.

Chrysalis Angel said...

Schroomy, I really wish you could start a column for "friends" or some such, "Pure Reciprocity" sounds bad, like - they linked to me, so I have to add these suckers...since you found me now, it would be nice to be listed under something that sounds like you want me there. :)

Chrysalis Angel said...

You can delete these once you read them btw. I just didn't see an email to contact you off site.

Anonymous said...

Any accident which results in jury should be treated seriously and the recipient should always be seen by a medical professional as soon as possible. In particular if people suffer injuries to the head or brain they should immediately to a professional and also if someone suffers a spinal injury they should be careful as this can result in serious injuries in the long term. If you or someone you know receives a spinal cord injury they should see a doctor immediately!!