Thursday, November 12, 2009

Management Flail

I hate being stuck in the middle.

It happens a lot, mostly because many of my colleagues still regard the ED docs as non-specialist, and think we will be their scut-monkeys. Old habits die hard, an all that.

Recently, I was presented with a challenging patient. A young woman, with a non-specific history of headaches, who had suddenly gone bananas. I apologise for the use of technical jargon. She had rapidly become delirious, with a fluctuating conscious level, and was spouting mostly gibberish.

Part of the work up was to include a CT scan, and we doubted our ability both to transfer her safely, and to convince her to lie still. ITU helped out with both of these things, but then pretty much washed their hands.

Her scan was normal, but bloodwork suggested and infective process and acute renal failure. Obs showed her persistently hypotensive, with diminished urine output. Getting near her, necessitated recurrent chemical restraint, physical restraint not being an option.

My medical colleagues were reluctant to admit her to the floor, concerned as they were that she was a) pretty sick, and b) difficult to manage safely.

ITU flat out refused to take her.

A 3 way argument between my boss, the medical and the ITU consultant ensued, with the end result being she stayed in my Resus room for 7 hours and then went to the medical floor. I can't help but feel that this once again paints us as the bitches in this piece, especially as less than an hour after arriving on the medical ward, she was transferred to ITU and tubed...

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