I'm definately a fan of second chances. I got mine today. Today I was on call which meant that I worked in the triage area called short stay and determined which patients were sick enough to be admitted versus those that could be discharged home with oral medications.
Short stay is a pretty crazy place. You see all kinds of patients.. the whole spectrum from patients that walked miles, starved, dehydrated, comatosed and on the brink of dying to patients who have a simple bout of malaria or gastroenterities. One of the most frustating parts however is how some patients are just brought in by stretcher from off the street and just dumped in the room with no one accompaying them.
I had 2 patients like that today.
The first patient of mine was brought in after he was found unconscious on the street. He came in gasping for air, a thick frothy secretion coming from his mouth. He must of been breathing 70 times a minute. Unconscious. no history and had a seizure right in front of me. a quick touch on his chest he was extremely warm and of coure rhonchorus sounds. I quickly placed an IV and told the nurse to administer 80mg IV lasix. She looked at me with a laize fair attitude as in "what's the use, i will take my own time". I then asked for the oxygen machine. 3 people were just sitting eating and drinking casually gossiping away. I turned to one of them. plz i need the oxygen. One of them just calmly stated don't worry when the patient gets admitted to the ward they will give oxygen. I raised my voice out of frustration with a bit of anger the patient may not make it. I need the oxygen now. The roused a few people the oxygen was found, lasix was given and i personally administered the aminophylline. |This guy was in florid heart failure. His accessory muscles started to weaken and finally when there was not more I could do i just let him lay there hoping he would get better. Was he already too acidotic? I saw the kussmaul breathing knowing that the end would be soon.
Right when i saw this, i had my second patient arrive in a stretcher. he was wheeled right in by a hospital worker and left there. No one to accompany him, ice cold. I turned to look around the room. all the staff had left. don't tell me everyone has left for lunch.This guy is going to die too. I went out in the hall and stated i needed an IV, fortunately i was able to find a nurse who wasn't too nonchalent about the whole thing. Unfortunately the patient barely had a pulse that was palpable. I ran quickly to the ICU and found a central line quit. None. Screw sterile techinque. I reached and found a 20 gauge IV canula and just blindly jammed it in the patient's inguinal area where i thought the femoral vein would be. Ah ha. god likes me. I hit it on the first spot. the catheter tread easily and i attached an IV line. using a peripheral line as a central line. that's a first for me. started fluids wide open. Next I felt gutsy and tried for the jugular. ah ha god likes me again for the second time. i did the same thing for the neck vein. 2 20 gauge IVS both in central veins with fluids running wide open.
I sent the patient up to the ICU equivalent on the wards. fortunately i have faith in the doctor in charge in that unit as he's pretty good. Lets see if we can save his life.
although i now found out that he came from jail. brought in by prison guards held on charges of murder. I guess maybe i would have preferred to be heroic on some other patient who had a good heart but i guess when you're a doctor all of that is irrelevatant. after all we did take the hippocratic oath.