This weekend was the walk through fire.I was to be incharge of the entire acute medical unit for two full days with the two juniors doing the rounds for the monitered beds which is the tougher bit with the consultants covering the either ends.
Friday was the usual take until a tough looking asthmatic came huffing and puffing into the AMU reffered by the GP.We started off with the usual nebs and steroids but half way through his saturations dipped and he started screaming his head off.I thought he was about to have a tamponade or something.His ECG had been fine,his gasses were allright.The med reg was hovering around ,so I immediately called him for help.He took charge and asked me to call the HDU,while he ordered for mag sulphate and aminophyllines to be given.The HDU consultant came with a junior,wheeled the man to the HDU,started an arterial line and continued with the nebulisers.Eventually he did not require an intubation.I felt a little sheepish at the end of the day.
We've done it all in our hospitals but there is a way to do it and you have to follow the way of the trust.
Saturday I apprehensively walked into the AMU and found an extremely efficient junior posted with me.We had our hands full,starting with a diagnosis of dissection in hand to a young lady admitted as pyelonephrites but found to have six toothbrushes in her tummy with a low saturation,there was a man with bilateral pulmonary embolism on warfarin with a hematoma in the abdominal wall and an INR of eight ,another with a trifacsicular block,a lady with fast Atrial flutter and fibrillation running a rate of 140 to 160 on diltiazem 240mg BD,digoxin 250mic,and on amiodarone infusion,a man with a GCS of 8/15,with dementia,sepsis with severe jaundice who turned out to have probable Ca pancreas with fully blocked biliary canal who needed a stent.At the end of the day he was walking all over the wards,I did not even recognise him.There was another with a sinister presentation of SOB without a cause and a blood pressure of 194/80 on one hand and 140/74 on the other with a funny AR murmur heard all over the precordium.There was no chest pain.The radiologist agreed to do a fast track CT angio.There was another gentleman whose heart rate was running a steady 35-40 in a sinus rythem without a cause with normal trops.He grinned his way through on salbutamol nebs for the next two days and it went on ,day became night and the night gave way to day-we saw dramatic recoveries and thanked the Lord,the last hour I found myself in the Marjorie warren ward for the elderly to asses the mental capacity of a lady with dementia...there Ruby all of ninety five was waiting to rib me...she sang away ,uninhibitted,joyfully...it sounded like, nursery rhyme to me...while I tried to make some sense of the paper forms before me ,my eyes fell on a flower vase with beautiful flowers and a copy of a New testament placed beautifully on the window sill of the ward,the first I had seen in the hospital.
Yes,I said tomyself,the hand of the Lord has been with me..in my first week-end take in the trust.
Friday was the usual take until a tough looking asthmatic came huffing and puffing into the AMU reffered by the GP.We started off with the usual nebs and steroids but half way through his saturations dipped and he started screaming his head off.I thought he was about to have a tamponade or something.His ECG had been fine,his gasses were allright.The med reg was hovering around ,so I immediately called him for help.He took charge and asked me to call the HDU,while he ordered for mag sulphate and aminophyllines to be given.The HDU consultant came with a junior,wheeled the man to the HDU,started an arterial line and continued with the nebulisers.Eventually he did not require an intubation.I felt a little sheepish at the end of the day.
We've done it all in our hospitals but there is a way to do it and you have to follow the way of the trust.
Saturday I apprehensively walked into the AMU and found an extremely efficient junior posted with me.We had our hands full,starting with a diagnosis of dissection in hand to a young lady admitted as pyelonephrites but found to have six toothbrushes in her tummy with a low saturation,there was a man with bilateral pulmonary embolism on warfarin with a hematoma in the abdominal wall and an INR of eight ,another with a trifacsicular block,a lady with fast Atrial flutter and fibrillation running a rate of 140 to 160 on diltiazem 240mg BD,digoxin 250mic,and on amiodarone infusion,a man with a GCS of 8/15,with dementia,sepsis with severe jaundice who turned out to have probable Ca pancreas with fully blocked biliary canal who needed a stent.At the end of the day he was walking all over the wards,I did not even recognise him.There was another with a sinister presentation of SOB without a cause and a blood pressure of 194/80 on one hand and 140/74 on the other with a funny AR murmur heard all over the precordium.There was no chest pain.The radiologist agreed to do a fast track CT angio.There was another gentleman whose heart rate was running a steady 35-40 in a sinus rythem without a cause with normal trops.He grinned his way through on salbutamol nebs for the next two days and it went on ,day became night and the night gave way to day-we saw dramatic recoveries and thanked the Lord,the last hour I found myself in the Marjorie warren ward for the elderly to asses the mental capacity of a lady with dementia...there Ruby all of ninety five was waiting to rib me...she sang away ,uninhibitted,joyfully...it sounded like, nursery rhyme to me...while I tried to make some sense of the paper forms before me ,my eyes fell on a flower vase with beautiful flowers and a copy of a New testament placed beautifully on the window sill of the ward,the first I had seen in the hospital.
Yes,I said tomyself,the hand of the Lord has been with me..in my first week-end take in the trust.
Comments