Catching up

I'd been so regular lately! I'd be lying if I said this last call didn't have anything to do with my lack of blogging lately. The day wasn't terribly busy, but we had a late admission, and then worked from about midnight to 1:30 AM trying to put in a central line on a demented elderly lady. I tried for about 10 minutes to find the femoral vein, my resident tried for another ten minutes, and then the attending spent 40 minutes, all without success! Obviously it's not comfortable to have a needle jabbed into one's groin, but I feel better knowing that it was necessary to get fluids and medicines into this lady, and she probably won't remember much as she was clearly altered.

I do have to say that after the hour of frustration, we eventually decided to change locations. I was up first (again) to attempt to access the left subclavian vein...and I got it first stick! Wish we'd started there.

After rounding on a few patients, taking care of issues and checking labs, I went to sleep at 3:30, hoping to sleep till 6:30. A call at 5:30, however, meant otherwise. A nurse told me that my patient was tachycardic (fast heart rate) and "doesn't look good." I went to assess her and when I noted her supraclavicular retractions and cold extremities, as well as the fact that she was pretty much unresponsive, decided transferring her to the unit would be a safe bet. I began those arrangement and paged my resdient.

For the next three hours we worked to stabilize her. Her ABG indicated her breathing would soon tire, so it was decided to intubate the patient. Since I'm going into anesthesia, I was eager for the first shot. The airway was obscured by thick, mucous-like secretions, and after I suctioned those, I could barely see the trachea, even using the best technique I could remember after spending two months on anesthesia. I couldn't get the tube in. Once again, my resident tried, then the attending. Even though we could still mask-ventilate the patient, it was becoming more urgent to intubate her. I called the O.R. and requested that any free anesthesiologist come to our assistance, as it was still early and the pulmonologists who usually work in the ICU weren't there yet.

A feeling of relief swept through the crowded ICU room when the anesthesiologist, accompanied by his OR nurse, showed up. Of course he nailed the intubation first try, but did note that the oversized crash-cart blades weren't ideal, and that the patient did have a very anterior larynx.

I didn't make it home till 3:30 PM. After reading the paper and having a bowl of cereal, I settled into a delicious slumber which lasted from 5:30 until 5:30 the next morning! I remember awakening around 3:00 or so and in my confused fog worrying I might develop a sacral decub from being in bed so long...