A Quiet Shift

I worked yesterday for what felt like the first time in a long time, although in reality it had only been a week. It was however, the first time I'd worked with my regular crew in quite some time, so there was a bit of catching up to do.

Lucky for me, there was only one patient on the unit, leaving lots of time for chit chat.

The patient we did have was a mess though. She was originally brought in for shortness of breath which was a bit of an understatement. She was traveling to our area to visit her family, and in the middle of the night her portable oxygen ran out. She was discovered unresponsive the next morning when she failed to show up for breakfast. When EMS arrived on scene she was satting at 60%, and had been for who knows how long. She was surprisingly alert and oriented when she arrived in our ED, and begged not to be intubated. The physicians reluctantly agreed, even though her gas looked like crap. She then bottomed her pressures, and ended up on a couple pressors.

She has a pretty impressive history. Two valve replacements, and both were leaking so badly that her ejection fraction couldn't be determined by echo. She'd had an abdominal aortic aneurysm repaired, currently had a carotid aneurysm, and the our radiologist diagnosed a thoracic aortic aneurysm from the CT we took. Her chest X-ray was impressive too, what with the sternotomy wires, mechanical valves, and the massive infiltrates around her massively enlarged heart.

And best of all was the fact that she was as sweet as could be. She was a real pleasure to be around. I got to put in another IV and draw lots of labs since she was on serial heart enzymes as well as everything else.

About halfway through the shift, we got a second patient--a 17 year old girl who attempted suicide by downing about a months worth of her psych meds--clonidine and citalopram. We didn't get her until about 15 hours after the fact and she was so stable it was a joke. When questioned as to why she was being admitted to the ICU, we were told that the ED doc was concerned about her pressure after taking the clonidine. She was 80s over 60s, which might have been concerning if she'd been a 57 year old male with a beer gut. But a 17 year old girl?

Her mom showed up at the ED for about 10 minutes, and then left for the airport to go on the family vacation they had planned, leaving the stepdad behind to deal with her daughter--both of who were supposed to be going on the trip as well. Her concern for her daughter was overwhelming. Not hard to see why the poor girl felt she needed to pull stupid stunts like taking a bunch of pills to get attention.

I took blood cultures, labs, and started an 18 gauge in her hand since her ED-special AC stick was super positional.

It was a good day. Lots of chit-chat and I went 4/4 on sticks/IV starts.