Okay, I really can't do these overnights anymore. I just woke up. Got eight and a half hours of sleep, and now I have to somehow fit an entire day, breakfast/dinner/whatever, and some more sleep, into the next ten and a half hours before I have to go to work again.
I got zero minutes of sleep overnight. There were more transfers to the ICU in one night than in the previous four. We got slammed, and there was nothing I could do about it. I'm in with one patient, whose blood pressure is 70/30, and then the nurse calls me into the room next door, 60/40, and then my intern calls a code on a guy across the hall who's in v-tach (ventricular tachycardia) and of course I'm the code leader, and of course I get to do my first ever defibrillating. Obviously I'd practiced shocking robots and fake patients, and I guess I'd seen it done a couple of times, but I'd never been the one doing it.
And this guy was some sort of mutant life form who didn't seem to need a properly beating heart in order to function. The way you see it on TV-- and, hey, the way I'd seen it before in real life-- is that someone needs to be shocked, they're not in good shape. They're lying there, out of it, not acting like a normal, live, person. Not this guy. He was talking, joking, asking questions. We're giving him electrical shocks, and he's barely noticing.
"No one gave me any f--ing food--"
"Clear!" [I shock him]
"Ow, that hurt. What the f-- is everyone staring at me for? I just want to watch the damn TV."
"Clear!" [I shock him]
"Ow! Where are my friends? My friends said they were going to visit--"
"Clear!" [I shock him]
etc.
We got him back to a stable rhythm, but the whole night was one crashing patient after another after another. I didn't go to the bathroom for ten hours. At 4AM, the floor resident calls me and says she's sending over two new patients. At 4AM.
In the morning, the attending asks me how the night was-- I can barely even stand at this point, every bed is full, how does he think the night was? And he expects me to be able to present a case to him? I can't even keep my eyes open.
And now I just want to go back to sleep again. Which I might very well do.
Thursday, July 15, 2010
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Hi there ^_^
ReplyDeletejust curious about the guy who you had to shock, who wasn't unconscious: What kind of rhythm did he have? I've heard about people with a torsades de point still being conscious and I'm wondering if it was that or if there's some other rhythm where you get (rare cases of) patients being still conscious. VTach maybe?