Monday, January 11, 2010

Missed It (2)

A healthy dose of schadenfreude.

A patient with end stage COPD rolled in. She also had a pulmonary malignancy, for good measure. The usual story - gradual deterioration, struggle to manage at home, sudden failure and collapse.

The Ambos reported low sats, recovering with hi-flow oxygen, but a fall in GCS concomitantly.

We see this a lot. I raised my eyebrows, ran the ABG. Acidotic, pCO2 15, pO2 15; both too high, too much O2. Turning it down, we aim for sats in the raange 88-92. Air entry thru the chest is poor, tight. I put it down to COPD, rack up the nebs, quietly confident.

We'll have her up and running in no time.

10 minutes later, I'm wrong. She's gone downhill fast; cyanosed, moribund, circling the drain. Fortunately, the X-Ray fairies have just been, and I gaze at the film.


We know it happens, know they're more common in these guys.

Still missed it.

Still: gives us something to aim at.

Chest tube slides in, a slightly hurried, messy affair, but I hear the air rush out, and five minutes later, the patient feels well enough to complain about the pain in her chest.

I have never been so glad to hear a complaint voiced.

Must try harder next time.

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