Currently spending the weekend recovering from MAU nights. At least I think it's the weekend, have been genuinely unsure of what day it is for some time now. Have decided one benefit of living on hospital grounds is the 30 second commute to work, but you do have to sleep through the noise of all the wailing ambulances during the day.
The last three nights have gone fairly well, with good variety of patients. Some of the most interesting included a gentleman in post renal renal failure with a urea of 50 and creatinine of 2550 (catheterise, IV fluids to match urine output plus 50mls to counteract post obstruction diuresis) whose creatinine had resolved to 250 by the end of the night. Another chap had come in via A&E with chest pain and been treated as an acute coronary syndrome despite no ECG changes. He was anaemic with a haemoglobin of 6.9 (further questioning revealed he had been GI bleeding for a couple of weeks) and actually had anaemia related myocardial ischaemia (stop antiplatelet meds and clexane, X match, transfuse, OGD).
The last night saw my bay turned into a secure unit - two known violent psych patients both admitted with shortness of breath, one from a forensic unit with two reassuringly large psych nurses guarding him was for male only nursing and doctoring due to his tendency to attack women. He was actually no trouble, but the other one caused issues demanding oxycodone in the middle of the night on top of his tramadol and co-codamol. Given that he had been admitted significantly hypoxic with a blood gas that showed a PO2 of 8 and type 2 respiratory failure I wasnt about to administer any more opiates no matter how loudly he yelled at me (because they can cause respiratory depression and oxycodone and tramadol are both quite strong anyway). The cynic in me wasnt convinced that he was truely in pain, or at least not the sort that would be aided by drugs - "where does it hurt sir?" "all over my body doctor" ..as he sat looking comfortable at rest.
The patient wasnt taking no for an answer from me so in the end I went to find the biggest SHO I could and got him to talk him down. Was quite reassured when he completely backed me up, explaining to the patient that I was doing the safe thing by not giving him the oxycodone and managed to calm him down.
Further 3am tutorials on liver disease from World's Most Enthusiastic Med Reg were made bearable by tea and cake, and we all made it through our final morning handover, me with three sick respiratory patients to present to a slightly grumpy highly seasoned respiratory consultant, and retired to bed delighted to have finished nights.
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