night 5, not a bad shift actually.

came on tonight to find only two new electives from todays list, which i thought was pretty impressive.

got called early to the cardiothoracic ward to consult on some young ivdu* guy with staphylococcal endocarditis on the posterior leaflet of his mitral valve, type 1 respiratory failure from a right basal pneumonia/effusion (probably the source) and subsequently acute renal failure (creatinine peaked at 500 yesterday) and diffuse abdominal pain. sounds like he has fired off septic emboli everywhere, including to his gut (mesenteric ischaemia) and his kidneys (acute glomerulonephritis). in fact, abdominal ct scan showed a splenic infarct too. intense gentamicin therapy could have also contributed to his renal failure. now on quadruple antibiotic therapy with flucloxacillin, ampicillin, metronidazole and gentamicin. i declared that he didnt need to come to the unit tonight, his multiple organ failure currently being mild and treatable on the ward. not a turf (cuz the patient wasnt mine to start with), but what a deflection! am i good or what?! =D

didnt really have to do much after that, just babysat for the rest of the night. all is well. =)

pretty lame world news tonight. nothing worthy of note. back home however, britains most notorious murderer and former gp harold shipman was found hanging in his cell in hmp wakefield yesterday morning. so whats the big deal? why the hell is this getting blanket coverage?

food of the night:

sliced pork and broccoli on rice

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* ivdu = intravenous drug user

posted by Chas at 07:46
go ahead, roll the donut!

 
night 4... much busier...

ovarian cancer lady desaturated bigtime around 0230, left side whiteout on cxr* compared to earlier in the day (only lower zone shadowing at that time). attempted chest tube for suspected collection (had bilateral effusions with her condition couple weeks ago, treated with bilateral drains) or even haemothorax, cuz the change had been rapid... nothing. just clot and lung adherent to chest wall, hardly any pleural space at all. so closed without drain. at which point she became periarrest. =(

intubated her and bronchoscoped her... turns out she had LOADS of gunk in her left main causing the collapse. picked up a bit after suction and washout.

boy, kept me busy for a while...

simultaneously, got called by the cardiothoracic ward for another lady getting into respiratory trouble. this lady originally presented with dysphagia and extrinsic compression of her oesophagus from a mediastinal (tracheal/carinal) mass, biopsied to be poorly differentiated scc* from either oesophagus or lung. i brought her down to the unit for cpap*, responded well, her trachea just being splinted enough to buy her some time until her carboplatin chemo due later today.

kept me busy too...

didnt have time to check out world events unfortunately. =(

food of the night:

jumbo hot dog with the works

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* cxr = chest xray, scc = squamous cell carcinoma, cpap = continuous positive airways pressure

posted by Chas at 08:35
go ahead, roll the donut!

 
night 3 almost over, a steady (but not hectic) night.

just a string of small tasks really, but kept me going along all night. an arterial line change here, a nasogastric tube drop there, that kinda thing.

new admission to the unit... 33 yearold guy with left ventricular variant of arrhythmogenic right ventricular dysplasia that arrested outside a neuro ward upstairs, having wandered over there after climbing two floors from his own cardiac ward. even though he has an implantable cardiac defibrillator inside him, the device didnt seem to kick in on the settings he had. he was down for just under 2 hours, with around 40 minutes of full circulatory arrest. his brother has already died of arvd, many more family members are currently undergoing familial genetic studies. already starting to show signs of cerebral hypoxia after being down for so long, i had to load him with phenytoin to terminate what looked like generalised seizures. fascinating case, but not good. =(

and yet another general icu patient taking up one of our beds! a young mother with grade 4 metastatic ovarian, had debulking under gynaecology, then developed pericardial and bilateral pleural effusions on general icu... came to us just before christmas for possible pericardial window, which wasnt actually needed as it turned out, so went back to general icu... and now back with us for renal failure and haemofiltration.

didnt really have time to catch up on news tonight. never mind. =/

food of the night:

prawn and courgette stir fry, mashed potato

posted by Chas at 19:02
go ahead, roll the donut!

 
night 2 almost over, another pretty good night. not much happened.

came in to find one really lame new admission from earlier in the day, some large lady with osa* requiring bipap overnight and awaiting a spot on the (full) respiratory ward, sent to us by general icu to make way for another new general icu case from the emergency department. have had a whole string of lame admissions lately. even had a ventilated subarachnoid haemorrhage with us over new years. whats cardiothoracic about that?

anyhow, took on one new admission overnight at around 1am... guess what? another lame general icu case that cant go there cuz general icu is full! an elderly copd* guy deteriorating on a general medical ward, possibly needing bipap (but NOT for intubation). turns out he has been fine all night with us on just 40% oxygen through a standard facemask! grr...

food of the night:

shrimp fried rice

news of note overnight:

guantanamo bay detainees have now been there for two years. hmm...

----
* osa = obstructive sleep apnoea, copd = chronic obstructive pulmonary disease

posted by Chas at 07:44
go ahead, roll the donut!

 
well, here we are again... 7 weeks have passed and im back on nights once more.

pretty good night actually. only 13 beds open tonight, all full. noone really sick, but there are two myectomy patients for hocm*, one just a little dodgy out of theatre. his co* was around 3.4 and ci* around 1.8. gave him a bit of inotropic support and he seems to be ok now, peeing ok. another elderly lady with a flail segment after a fall suddenly desaturated overnight, needing a chest tube. 3000ml out stat, serous, not blood. probably due to her cald* instead. nothing much else to report otherwise.

had plenty of time to catch up on news items through the night:

- american homeland security secretary ridge has stepped the country down from alert level orange to yellow. hmm...
- greg rusedski has tested positive for nandrolone. hmm...
- we can now get cancer from eating farmed scottish salmon (toxins and shit in the feed). woohoo...
- saddam has been given official prisoner of war status. well i never...
- first pics of lady louise windsor (taken by her uncle prince andrew!) released by the palace... she was on our nicu*!
- unofficial us delegation visits the nuclear complex at yongbyon, north korea. hmm...
- herges adventures of tintin (first appeared in 1929) are 75 years old! well worth checking out for those that havent before. did most of them myself when i was a kid.

food of the night:

cheese & cauliflower cornish pasty

right, better go take this vancomycin level. surely intensive care nurses here ought to be certified to venesect? *sigh*

oh, my fellow comrade on the unit tony wants the world to know that hes back from his new years holiday. he was in paris for nye. wtf?

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* hocm = hypertrophic obstructive cardiomyopathy, co = cardiac output, ci = cardiac index, cald = chronic alcoholic liver disease, nicu = neonatal intensive care unit

posted by Chas at 07:32
go ahead, roll the donut!