Wednesday, November 28, 2007

River Of Dreams

In the middle of the night...

Doing an extra night tonight for a colleague. Normally this would provoke a great deal of grumblage, but as it's because he's a new daddy, we don't mind. I sure as hell am getting old tho'. I used to be able to do a week of these and not feel it, but here I am after three, tired as a wet kitten, and irritable with it. Like a bulldog with a mouthful of wasp.

Anyway...

Further evidence, as if it were needed, that people throw off all sense of personal responsibility when they step through our door. Twice tonight I have had people gesticulating wildly at me, alerting me to the fact that they are bleeding.

Not unreasonable, I hear you think. Well, no, not usually; but in these cases, the bleeding was from cannulation or venepuncture sites. Not from horrendous trauma, or awful limb-falling-off type accidents.

But because the cotton dental roll we place over these pin point hole wasn't taped on hard enough.

And they are always stunned when I stroll over and press on the wound with my thumb. Shroom's Blunt Haemostat. Amazing. Quite why these otherwise healthy(ish) and intelligent people can't summon either the nous, or strength, to think of, and then do, this themselves is beyond me. Instead they stand there, or sometimes move around a bit, to ensure even coverage. Oftimes they wave the offending limb, but always held downward, never upward. And they never, ever press on it. Ever.

Folks, I'll let you into a secret. If you can see a bleeder, and you can press on it, it will stop. I don't care how big. If your finger fits over the hole, that's the treatment, right there. But keep it to yourselves...

My favourite patient of the night (so far) was a young girl, visiting family. (i.e. not local... been to several other hospitals before...) Presenting complaint? Total body pain. Another personal favourite. Atraumatic, mind you. Total body pain is quite reasonable if you've, for example, been sat on by an elephant, or fallen out of a plane. But sudden onset, atraumatic total body pain? Well, we do see this, but it tends to be in a certain demographic of patient. For fear of generalising, or being accused of bigotry, I'll leave you to guess.

Needless to say, her first words to the triage nurse were to inform us that only morphine works for the pain, and that's what she always has. Her triage obs were all remarkably stable and normal. Despite several publicly agonising trips to and from the bathroom, pointedly in front of the doctor's bear pit, I explained that without a diagnosis, or any clues as to a possible diagnosis, I wanted to try other analgaesics first. Simply telling me that your previous treatment plan is i.v. morphine and home does not encourage me to give you some. Cruel, cruel Shroom.

Either way, when confronted with the harsh realities of the analgaesic ladder, and need for assessment and diagnosis, she decided to go home instead. Her gait on the way out was markedly free of the tortured limping and groaning that had characterised it a few minutes previously...

Lastly an SVT. This particular dysrhythmia is one of my favourites (sad, sad bastard) because, in my experience, it rarely compromises people, and responds well to a quick blast of adenosine. My SHO, running the case in his inimitable style, opined loudly to us all that he didn't see the point in 6mg as a starting dose as it "never works"; this minor rant against the system, and specifically the part that was compelling him to give this homeopathic dose of adenosine, continued until about 0.8 seconds after he injected the adenosine, when the patient flipped right back into sinus.

I guess protocols sometimes do make sense. Who'd have thunk it?

Oh, and the CherryPicker has started his own blog. Check it out; his tale is well worth hearing, although I can't vouch for his writing style... he did want me to offer more biog details about him here, but I'm thinking he can tell his own tale now. One doctor's battle with booze, and a reminder perhaps, of how close we all sail. Anyway, enough plugging.

6 comments:

Harry said...

Maybe they felt if they pushed on the cannula it would snap in their arm and they'd somehow die a horrible death?

As for the SHO, well I hope it worked out okay in the end...

Ladyk73 said...

I have a question about you morphine girl...if I person presents to the ER and tell you they are a pain-pill addict, and are in a lot of pain (from withdrawl)....

What would you do?

DrShroom said...

Withdrawing junkies get referred to the detox team; they get zero morphine

DrShroom said...

Harry - the canula was out; they were bleeding from the puncture site, post removal

Faith Walker said...

Today a guy accidentally pulled his venflon out while in the shower and not surprisnly, it bled. Also, it was in the shower, so it spread. All over the place.

Did he put pressure on it? No.

I had to go and get gloves, gauze etc and come and do it for him. Then, and only then, after applying pressure did he say "oh, i can do that", and took over from me.

Honestly, i wonder sometimes if people have a common sense implant on admission to hospital.

Chrysalis Angel said...

Hang in there shroomie...fatigue wears one down, as you know.

First aid should be taught in school, I think. I had blood that soaked through my clothes during treatments...the person taking me freaked. I didn't even notice, and looked down to see it had saturated through the arm of my shirt and coat. I said "Oh, it wasn't taped tight" and held pressure for a while, re-taped it myself and threw the pre-treated clothes in the wash. People panic when they see "red" stuff.