Wednesday, October 29, 2008
Compatibility
The boyfriend says to me: "I love it when I clean my teeth after you, you squeeze the toothpaste tube out all nicely for me." We are so perfect for each other!
Friday, October 10, 2008
Stone cold sober and very aware of it
I have been doing cover this week - my usual 9-5ish and then covering the wards until the night staff begin at 9.30. Last night I was bleeped.
"Hello, this patient is not looking well, will you come?"
"Umm, sure, where are you?"
"XXX ward."
"OK what's the patient's name? What's wrong with her?"
"XXX. She had a pleural tap earlier, and she's looking so pale, and she's not breathing right."
"What's her respiration rate?"
"Er, not sure, but not much..."
(Giving up) "OK, if you could get a set of observations now, I'm on my way."
I get there. There's noone around so I just head to the patient. She's on her bed, slumped back, looking pale and limp. Her husband is next to her, not doing anything, just looking a bit worried. I ignore him. I put my hand on her shoulder and ask her if she's ok. She moans and pauses for ages and ages, says she's tired. Her respiratory rate is 8. I put my head around the curtain and get an obs machine. I do the sats first. They're 89 - not terrible, but less than they should be. By this time a nurse - a good one, not the one that called me - comes in to the curtain and asks if I'm ok. I ask her to get some oxygen. Her blood pressure and pulse are ok. Her pupils are small. I do a quick examination of the rest of her, concentrating on lungs, but find absolutely nothing wrong. The nurse comes back. She says "How much oxygen do you want doctor?" I am taken aback for the smallest of seconds at the fact she's asking me with such sort of respect. "10 litres." I say with confidence, not for any particular reason. She puts the mask on and her saturations very quickly come up to 99. I check the drug chart. She's been given 60mg of morpine in the last hour. A lot for a little lady. I go out, interrupt the nursing handover (ah, the reason why noone was with her) and ask the lady's nurse, the one who called me, to draw up some naloxone. "Na ... naxalo ... what?" "Naloxone, you know, the antidote to morphine." "Naxalone?" I get the BNF and open it at the page and give it to her, and write it on the drug chart and give it to her. "I'll check, I don't think we have any ..." "Umm, I really think you do have it, any wards would really - might you go and check?" She goes. I bleep my SHO, cos even though I'm pretty sure it's a morphine overdose, I have never dealt with it before and I was scared. The SHO says she'll come straight up. I go back to the patient. She's still so drowsy. The nurse comes in with the little vial. I'm thinking should I give it? but then my SHO comes in. She does a quick exam. "Yeah, give the naloxone." she says, not really looking worried. I push it in. It's amazing. The lady takes some deep, deep quick breaths and starts getting all jittery, as if she's been switched on. "What is this? I'm feeling so sick, what is this? What did you do?" I reach for a vomit bowl, put it under her face, and I smile. It was so fun. I explain to the lady and her husband what had happened, and said I was sorry for ignoring him earlier. I said we'd keep a close eye on her, but she would be fine. She thanks us. It was fab! Maybe next time I won't need the SHO... ;-)
"Hello, this patient is not looking well, will you come?"
"Umm, sure, where are you?"
"XXX ward."
"OK what's the patient's name? What's wrong with her?"
"XXX. She had a pleural tap earlier, and she's looking so pale, and she's not breathing right."
"What's her respiration rate?"
"Er, not sure, but not much..."
(Giving up) "OK, if you could get a set of observations now, I'm on my way."
I get there. There's noone around so I just head to the patient. She's on her bed, slumped back, looking pale and limp. Her husband is next to her, not doing anything, just looking a bit worried. I ignore him. I put my hand on her shoulder and ask her if she's ok. She moans and pauses for ages and ages, says she's tired. Her respiratory rate is 8. I put my head around the curtain and get an obs machine. I do the sats first. They're 89 - not terrible, but less than they should be. By this time a nurse - a good one, not the one that called me - comes in to the curtain and asks if I'm ok. I ask her to get some oxygen. Her blood pressure and pulse are ok. Her pupils are small. I do a quick examination of the rest of her, concentrating on lungs, but find absolutely nothing wrong. The nurse comes back. She says "How much oxygen do you want doctor?" I am taken aback for the smallest of seconds at the fact she's asking me with such sort of respect. "10 litres." I say with confidence, not for any particular reason. She puts the mask on and her saturations very quickly come up to 99. I check the drug chart. She's been given 60mg of morpine in the last hour. A lot for a little lady. I go out, interrupt the nursing handover (ah, the reason why noone was with her) and ask the lady's nurse, the one who called me, to draw up some naloxone. "Na ... naxalo ... what?" "Naloxone, you know, the antidote to morphine." "Naxalone?" I get the BNF and open it at the page and give it to her, and write it on the drug chart and give it to her. "I'll check, I don't think we have any ..." "Umm, I really think you do have it, any wards would really - might you go and check?" She goes. I bleep my SHO, cos even though I'm pretty sure it's a morphine overdose, I have never dealt with it before and I was scared. The SHO says she'll come straight up. I go back to the patient. She's still so drowsy. The nurse comes in with the little vial. I'm thinking should I give it? but then my SHO comes in. She does a quick exam. "Yeah, give the naloxone." she says, not really looking worried. I push it in. It's amazing. The lady takes some deep, deep quick breaths and starts getting all jittery, as if she's been switched on. "What is this? I'm feeling so sick, what is this? What did you do?" I reach for a vomit bowl, put it under her face, and I smile. It was so fun. I explain to the lady and her husband what had happened, and said I was sorry for ignoring him earlier. I said we'd keep a close eye on her, but she would be fine. She thanks us. It was fab! Maybe next time I won't need the SHO... ;-)
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