Just finished my second of three weekend late on-call shifts. This evening has been eventful. Firstly, weekends on call are generally a lot busier than weekdays on call because there are fewer staff on at the weekend so jobs get done later and there are usually more to hand over. So at the beginning of the shift I had a long list of things to do which required some prioritisation. A few of the jobs were things like checking blood levels of drugs such as digoxin and gentamicin, which have to be done at a certain time, others included a mountain of cannulas, a few bloods to take and check and a couple of drugs charts to be re-written.
I was busy attempting to take blood from one chap for a digoxin level, when I noticed the chap in the bed next to him stand up somewhat unsteadily. Now if patients are prone to falls, they often have a falls alarm attached to them and to the chair/bed so that if they try to stand up a siren gets activated and a nurse comes to tell them to sit back down. No such alarm sounded as this gent stood up so I carried on with my attempts to get blood. A split second later and the standing chap turns around and topples forward, landing on his face with a truly awful thud, and then the falls alarm sounds. Sirens wailing, I leapt to the gentleman's side, poor thing had sustained a rather large scalp laceration and was hosing blood all over the floor, flailing gently on his back and looking confused. Thankfully an army of nurses appeared and together we applied compression to the wound and hoisted him back into bed. I checked over the rest of him - no apparent C-spine tenderness, no bony tenderness over the hips or long bones. No blood coming from the ears. Checked his drug chart to see if he was on warfarin (he wasn't)
- warfarin + head injury = CT Scan. Instructed nurses to start regular neuro obs and bleeped my SHO for an opinion on whether to glue, steri-strip or suture the wound. We glued him back together and all was well. Went back and obtained somewhat delayed digoxin level.
Next job was to certify a death. On examination.. patient looks dead. Actually she kind of looked asleep, but very blue around the edges. I listened for heart sounds and breath sounds, felt for a central pulse, checked pupillary reflexes and response to supraorbital pressure, none of which were present (thank goodness otherwise this may have confused the issue). Told the patient/body to Rest in Peace as I was leaving and felt a little silly. Documented my examination in the notes plus time of death, the absence of a pacemaker and Rest in Peace. Felt a little sad.
Next job was to work out how to hide from nurses on the ward waiting to pounce with additional jobs for me to do, while continuing to carry out the jobs on the ward I already needed to do. Failed, and picked up a review of a patient with high blood sugars (around 27, normal being roughly 3-7). Reason for admission of this patient was.. high blood sugars. Chances of me, the inexperienced FY1, managing to single handedly regulate this patient's blood sugars over the course of one on call shift were slim. Also, I find prescribing insulin a little scary. It's a dangerous drug and can certainly kill people in overdose. There are many many different preparations, all with different durations of action, and I really wasn't quite sure what to do. Cue time spent with the BNF (drug book) and a phone call to my SHO for advice. We settled on a small stat dose of 4 units of Actrapid (short acting insulin) alongside her regular intermediate acting insulin.
Managed to escape the Elderly Care nurses to take blood from an outlying patient near the end of the shift. As most NHS hospitals tend to be on "black alert" due to a shortage of beds, some of the less sick patients from one department can end up seemingly in any other part of the hospital. This chap for example, was parked in Urology. I found another chap in Obs and Gynae on yesterday's shift! I'm not sure what happens after black alert.. must be brown alert!
No comments:
Post a Comment