Saturday, January 10, 2009

Doctor, My Eyes

Never let it be said I am prone to hero worship, or hyperbole.

But, I witnessed the most remarkable act of resuscitation recently. It has to be said that I should probably have been less impressed, because, really, it should be bread and butter, but...

The calls on the BatPhone always bring a frisson of excitement to a resus junkie like myself. We got two in short order, both elderly, both low GCS. One carried a warning of low pulse, the other of high BM. Daytime brings high staffing levels, relatively speaking, so the first contestant went to one of the bosses and an SHO; patient didn't look too bad when she rolled in, so I left them to it and tried to prep for number two.

High sugars and low conscious level smells like diabetic ketoacidosis and cerebral oedema to me, and it ain't a nice smell.

When he rolled in it smelled worse. A veritable husk, wrapped in his own duvet. When the paramedics bring a punter in wrapped in their own duvet, it is never a good sign. This patient's duvet and feet were caked in blood and excreta. You would be correct in surmising that this is not a good sign, either.

What control had neglected to mention was that the patient had been found in a pool of his own melaena; semi digested blood, born at the top end, voided at the bottom end. He had also not had a blood pressure.

I've seen some dry folks before, some real crispy critters; but this guy - his eyes were shrivelled. Concave, flaccid, like party balloons two days after the last guest clocked out. I have never, in all my born days, seen anything like it.

Needless to say, access was an issue. I am increasingly in love with the Easy-IO, and drill that fires an i.o. needle into the bone of your choice, sweet as pie. Two of those bad boys gave us a start; medical students, eager for teaching, found themselves press-ganged into pushing fluids.

Two litres later and his eyeballs were back to normal. A few veins appeared, and more access; more fluids, more drugs. He came as close to arresting as it's possible to do an not. If you see what I mean.

He made it out of the resus room, but I don't hold out great hope for the final outcome. It's a mark of just how sick he was that, despite three hours of aggressive resuscitation, he left with a pH still below 7.

Sometimes hard work does go unrewarded.

No comments: