Had a discussion with my SHO today about one of our dear old patients with dementia who frequently and loudly calls out the word "OW-OO" when awake, as if she might be in pain. Daily attempts to discover any potential source of pain have been unsuccessful, and the numerous pain medications she's taking are merely making her drowsy.
-Yeah, her abdominal x-ray showed that she's constipated up to the eyeballs.
- Are we giving her stuff for that?
- Oh yes, she's had suppositories and things.
- Could we not give her an enema?
- People who have enemas tend to explode themselves.
- I'm sorry?
- Yeah we had one lady who was bunged up like this so we gave her three enemas in one day and she exploded EVERYWHERE and then couldn't stop and gave herself an acute kidney injury because she'd dried herself out. She nearly died.
- Well that would be a crap way to go..
On another note, syphilis is on the rise again. I learned today that syphilis serology is part of the routine dementia blood screen in this Trust. I also learned that it is one of those samples that needs to get to the lab very soon after it has been taken (this entails a lot of fast walking as the pod system is not quick enough or reliable enough to be trusted). Most tests for hormone levels are the same (except cortisol, which is very stable) and lab technicians insist that a lactate sample needs to arrive instantaneously for fear of degredation (although I did hear a seasoned haematologist disputing this fact at great length the other day).
One of today's numerous trips to the lab involved me pitching up at the hatch, brandishing several samples and saying something along the lines of "I've got syphilis, vitamin D, a PTH, a stool sample and a blood gas." The grumpy bearded lab technician raised an eyebrow and muttered "Everyone's got bloody syphilis these days.."
I waited for the blood gas results, which were rather interesting. All the values were normal, except the PaO2 (arterial oxygen level) which was 23.7. Now if you know what I'm talking about you'll be thinking that the patient is clearly on supplemental oxygen, as normal PaO2 is around 13, and the partial pressure of oxygen in room air is 21 (21% oxygen in air) but nope, patient was on room air, and had a suspected pulmonary embolus so the PO2 should have been low..
I was a little stumped, until I figured out that the sample must have had an air bubble in it which affected the result. Although, this must mean that the stroke unit is an exceptionally oxygen rich environment as 23.7 is higher than the norm.
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