well, penultimate shift on the unit over... strange kinda night shift.

having got fri/sat/sun nights in this run covered by seema and mark, i just have to work my last two shifts ever, mon/tue nights, and then im done.

an elderly indian lady with three vessel disease and a very unstable inferior mi* kept me busy most of the night. 4 stents had been stuck in her rca*, lad* left with diffuse disease, balloon pump going, haemofilter going, fairly low doses of noradrenaline and milrinone by all accounts, keeping a poor right ventricle alive with high filling pressures, cpap* on and an order for no surgical and no further medical intervention.

got handed over a lactate for her of around 3 with stable ventilation at the start of shift. however, lactate gradually crept up overnight to almost 5, no new changes on her 12 lead, no further chest pain. i was convinced her right ventricle was either becoming more ischaemic or had packed up altogether...

cranked up her inotropes, more filling, tried to float a swan. couldnt get into the ventricle, just couldnt. frustrating. abandoned eventually and tried the oesophageal doppler instead. still couldnt pick up any decent flow. meanwhile, her ventilation had deteriorated rapidly, partly cuz i had her lying flat for a while. had to intubate. things not good and getting worse. oh dear...

cardiology arrived by the end of the night. turns out her right ventricle is now akinetic on echo. no wonder i couldnt float the swan, there was no forward flow!

dont hold out much hope for her in this state. guess ill find out when i return for my final night shift of this job. =(

food of the night:

didnt have time to eat anything. bugger.

news:

didnt get a chance to catch up on any world news either this shift.

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* mi = myocardial infarction, rca = right coronary artery, lad = left anterior descending artery, cpap = continuous positive airways pressure

posted by Chas at 13:00
go ahead, roll the donut!