Early Morning Thuds

Now being a doctor means that no day is rarely ever the same in hospital. You get different patients on your ward round, emergencies for your patients crop up (usually around 5 or 6 pm – just as you are planning your swift exit from hospital), and you get the opportunity to do things that you never anticipated that day (from the fun stuff like putting in a chest drain to the less fun stuff like manual faecal evacuations…I’ll let you sketch the mental image of that latter task….!).

What you don’t often anticipate is when you have to deal with other doctors random patients. Usually this is a case of wrong person, wrong place, wrong time…

So there I was having snuck onto the post-operative surgery ward at 7.05am – all the patients fast asleep, the daytime nurses in the office have a verbal handover of the patients from the night nurses (no, not the cold medicine…) and the night shift doctors likely tucked up in the mess dreaming of the bleep well, not bleeping. In case you’re thinking why was I a) in work so early and b) on a surgical ward when I am currently working in the intensive care unit, I was in fact collecting data from surgical patients notes for an audit (i.e. a look at hospital protocols) on peri-operative (i.e. before, during and after) temperature recording.

I have my back to the ward bays as I sift through notes (still, I might add, dreaming of my first coffee of the day) when I hear the dreaded shuffle of an early-riser patient. I turn the pages of the notes I am looking at that fraction quieter in a vain hope not to draw eye contact with the patient or invite a question about her operation (all patients seem to think every doctor will know about THEIR operation for some reason). Luckily I escape the question and the eye contact.

The shuffling behind me continues….

“Oh, this patient didn’t have his temperature measured…” I muse to myself as I stare at the notes…

THUD.

I look up from the notes staring at the wall, simultaneously thinking “that is NEVER a good sound in hospital”…

I peer over my shoulder to see a clear corridor…but the THUD came from somewhere. Hang on, where’s my ‘shuffler’? As I peer over the nurses’ station desk I discover the previously shuffling patient, well, not shuffling.

In fact she wasn’t doing much of anything. She was out cold on the ward floor.

At 7.07am my audit data collection comes to an end and a full 53 minutes early I have to work as a doctor…

“I want some help at the nurses station immediately please”, I try to say in a not too annoyed tone.

I walk to the patient (rushing in medicine does nothing and only leads to mistakes) and check she is breathing and has a pulse. She does. That is good. I hate death certificates. I grab her legs and raise them, just as a two helpful staff members stroll over.

“This patient has just collapsed, I don’t know who she is but I want you to 1. Connect up a 15L high flow 100% oxygen to her via a face mask from a portable canister 2. Connect up some remote monitoring for heart rate, blood pressure, oxygen saturations 3. Get a pillow under her head 4. Get me her notes please and 5. Get me a coffee.”

I’m kidding about the last request, obviously…though I did really want one!

They beaver about and get all these bits done very efficiently. I stand there holding her legs up still – my mind thinking that this is in all likely a syncopal collapse (a faint) post-operatively. I ran through the resus protocol A, B, C, D, E:

A: Airway – patent (she was starting to moan which tells me her airway is open)

B: Breathing – respiratory rate 15, oxygen saturations 100% on 15L of high flow oxygen

C: Circulation – heart rate 80bpm, blood pressure 88/55, capillary refill time <2sec

D: Disability – pupils equal round and reactive to light and accommodation, all limbs moving.…AH! I haven’t asked for a blood sugar…

 “Blood sugar pleases guys after you’ve done the first 4 things”…

Blood sugar was normal.

E: Everything else – no obvious cuts or bruises from her fall (but you can’t rule out a surgical bleed)

While someone takes over the patient’s legs I have a quick look through the patient’s notes – 38 year old female, day 1 post gynaecological operation, hasn’t had much intravenous fluids since the operation, hasn’t taken any pain relief (and the nurses verbally she hasn’t been drinking much fluid orally either…).

So let’s recap:

A dehydrated, post-operated female patient with a low blood pressure who decided to go for a stroll….

This is most likely a syncopal episode.

So, with all that in mind, we get this lady back into bed (with regular 30mins observations, some intravenous fluids to pick up the blood pressure, some pain relief drugs and some biscuits). It’s still 20 minutes until I am supposed to be working as a doctor but I call the surgical team that operated on this patient and handover what has happened.

7.55am….

I sigh, still 5 minutes until I’m meant to be ‘working’…Hmmm I wonder if the NHS would give this unofficial doctor time I have just engaged in as time off in lieu…?

I know, that’s what I thought to…unlikely!

Like I said at the start, no day is the same and something tells me that similar encounters with patients will pepper the years to come…

Have a great week everyone.

Dr Nick

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s