I have once again been thrown in at the deep end, starting my placement in MAU on nights. I'm currently unsure what day it is. Having never done nights before this was all very new. Main concern was how on earth I was going to manage to stay awake for 12 hours in the busiest department in the hospital and practise medicine to a reasonable standard on all the really quite unwell GP and A&E admissions.
Strategy for first night shift was to wake up mid morning, do lots of exercise to knacker myself out and then sleep for a few hours in the afternoon.
8pm handover resulted in me being assigned an entire bay of 10 patients to look after, and to clerk, treat and triage any new admissions to that bay. I also got handed an SHO bleep, and a crash bleep.
Patients in my bay included a paracetamol overdose (check levels, continue acetylcysteine), a young diabetic ketoacidosis (repeat blood gas, monitor blood glucose, continue fluids and insulin), a seizure ?cause (check bloods, arrange urgent CT and report), 2 young patients with severe community acquired pneumonia (for IV antibiotics), a tall thin young man with a pneumothorax (chest drain in situ) and one chap with terminal cholangiocarcinoma presenting with gastric outflow obstruction, vomiting and hypovolaemic shock (arrange erect CXR and AXR, NG tube on free drainage, antiemetics, fluid resuscitation, keep seniors well informed).
We also had three confused gentlemen, one of whom escaped from his bed around 2 am and, gown flapping the breeze, buttocks defiantly on show to the ward, pulled back the curtains of his neighbour and proceeded to relieve himself thankfully beside his bed and not onto him! "OI!! He's pissing at me! Bastard! NURSE!"
Around 3pm our bright eyed and enthusiastic Med Reg insisted on giving all the juniors a formal powerpoint tutorial on upper GI bleeding. Thought it was a nice touch that he made us all a big pot of tea to drink while we sat and tried to stay awake while he talked about the most recent papers in the field.
Around 6am the crash bleep went off so the Med Reg and I ran across the hospital and up three flights of stairs to find a proper cardiac arrest in full swing on one of the surgical wards. I joined in with chest compressions. The patient was in VF and was shocked 5 times before going into asystole. Resus continued and somehow he went back into sinus rhythm with an output. This was short lived however as he then went into VT. 7 shocks, many antiarrhythmics and some potassium later his heart decided to stay in sinus rhythm and the patient went to ITU. Apparently an echo showed a massive ventricular aneurysm, probably secondary to a huge heart attack, so sadly he probably wont recover from this.
8am handover involved presenting the sickest patients to the day team and then home to bed. All in all a good first night.
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