Wednesday, March 10, 2010

Adventures of the day.... I hate adventures.

My day had started off with an adventure in hypoglycemia. Young patient, early 30s, had a gastric bypass a few years back. For the last 2 years, she'd been having issues with hypoglycemia because her pancreas decided to go apeshit at her. She eventually came in because of a loss of consciousness r/t hypoglycemia. The doctors discovered she had reactive hypoglycemia. (Long story short for the non-technical types: person eats a meal, blood sugar increases. Pancreas goes "HOLY SHIT THERE'S SUGAR! ATTAAAAAAACK!" and sends a flood of insulin, dropping the blood sugars like a ton of bricks.) I told her to give me a call the moment she started feeling funny.

So around 1640 I get a call "...ssuugar low. trieddd.. drink juice" and that was it. I experienced an impressive bout of tachycardia and ran to go check on her. She was barely responsive with eyes closed. Checked her sugar on our machine, 56. Apparently she went down to 24 yesterday. I tried to contain my panic as she started twitching uncontrollably and looked for a mobile computer so I could look up the Doctor's number and be able to scan in the Glucagon. Gave the IM Glucagon and waited a little while; she didn't come out of it and continued twitching/jerking. Decided it was time to call RRT to come keep an eye on her for me. When RRT came I took the opportunity to grab another Glucagon (our last one!) from the Pyxis and dose her. Her sugar went up to 118 but she still didn't wake up.

Finally after about 45 minutes she came to, thank god, with a FS of 134. I spent the rest of the shift terrified she'd do it again. Luckily, her sugars stabilized, at least till I went home. Curious to see how she is today.

Then I had a shift-change adventure with a confused patient. She was A&Ox3 at the start of shift, because that's how these things work. The trouble started around 1930 when she started asking for a sleeping pill. I called the doc, and he didn't order any because of her recent stint with intubation in the ICU (good call!) and wanted to make sure her respiratory status was good before worrying about sedatives. But the patient didn't let it go. Every time I went in the room she demanded her pills. I explained what was going on and why she couldn't have her normal sleeper, but she didn't understand. She kept asking me to go to the middle bedroom and get the little pill bottle out of the bedside table. Her daughter even tried to reorient her, and we took a short walk out of the room to show her the hospital hallway. No luck.

Eventually we agreed that we'd just turn out her lights, give her earplugs, and hope that she settled down enough (after not sleeping for 2 nights) to pass out. Her son was staying the night, and with any luck he'd keep her calm.

So come shift change, I get rung at by the tele monitor saying that her HR was steadily climbing. 120s, "okay, she's AFib, it happens." 130s, "hm this is weird". 160s "holy shit let's see what's going on."

So I run down the hallway and go in the room to find her legs out of the bed, and her lying at an awkward diagonal. I ask her where she's going and she said "I fell." For a moment I freaked out because patient falls are a huge issue. Then I thought to myself, if she ended up on the floor, there's *no way* she's strong enough to get back in the bed like this. She's a moderate assist just to stand from sitting. So I assist her to sit at the edge of the bed, and the bed alarm went off. Okay, so the bed alarm was armed (I'm pretty obsessive about the bed alarm now) and functional, so if she had fallen out of bed, it would've rung before.

I look at her, and notice she's very upset and teary eyed. I asked if maybe she had a bad dream in which she fell. Lord knows we've all had that awful "tripping off the edge of the sidewalk" dream and then jerking awake slightly freaked out. She said that she had, and that she needed to use the commode. The oncoming nurse and I helped her to the commode and I stood by while she attempted to go (with no success). We helped her back into bed, and she continued on about getting her pills.

Meanwhile her son in the pull-out bed lifted his head a few times, but at no point did he attempt to help us reorient his mother. What's the point of spending the night if you're not going to be useful?! It's not like it's fun or comfortable staying in the hospital. Help out or go home...

Anyway, we get her settled and comfortable, turn the bed alarm back on, and I went home. I look forward to reading the night's notes...

I can't wait to get off the Tele floor. It's a spirit-crushing, down-heartening hell-hole lots of nights. Makes you sad for the elderly and pissed off at the family who thinks that death can be prevented indefinitely. We all have to die someday, and we all have to die of something. Why torture people in the interim?

1 comment:

  1. The tele quad is my absolute least favorite place to be. Unfortunately it is where I will be spending most of my time for the next few months. *sigh* I feel your pain. =)