One of my FY1 colleagues who is on nights this week told me she cried three times overnight because she'd been stuck seeing several sick patients all at once and the nurses kept pestering her about all manner of minor things like prescribing fluids and writing drugs charts. Some nurses can be very insistent, literally shoving charts under your nose while you're trying to write in the notes, or brandishing a slightly abnormal set of obs in your face or just coming up and talking loudly at you while you're clearly busy with something else.
The trouble is, if the nurse has told me about something, it is then my responsibility to do something about it, not least because the nurse will note down my name and write "doctor informed" in the notes, even if "informing me" has involved yelling "doctor doctor patient has high resp rate" from across the nurses station, then buggering off leaving me to discover for myself that the resp rate is 18 (not that high) but the sats are 76%.
I'm sure I too am guilty of forgetting that the nurses are incredibly busy with other things when I ask them to do several things all at once to sort out a sick patient, but it is frustrating when they come out with things like "I'll finish the obs round in here then I'll give the IV frusemide" [to my patient who is gasping in the corner while all the other patients in that bay are sleeping peacefully].
Yesterday's twilight shift was a little less frantic than the previous two. There was an interesting patient admitted to SHDU, a 70 year old man who had come off his motorbike and fractured 9 of his ribs, several in two or more places giving him a flail segment, and a lung contusion. He was in a lot of pain, unsurprisingly, and my first task for him was to list him on the emergency theatre list for an anaesthetist to put in a thoracic epidural.
Listing someone for emergency theatre involves filling in a form and venturing into the emergency theatre waving said form like a white flag, to be grilled by whichever anaesthetist is on duty. Nobody had really briefed me about quite how to do this so naturally I wandered (not in scrubs) in looking a bit lost and got waved back into the scrub room for being "fully clothed". Cue conversation yelled from doorway to anaesthetist.
I returned to this patient a couple of hours later because I had been asked to repeat his blood gas. I found him to be rather a lot more drowsy than before, and was slightly concerned this may have been to do with the morphine PCA (patient controlled analgesia, IV morphine at the touch of a button) and large quantity of tramadol he had been given. Hid blood gas showed a mixed respiratory and metabolic acidosis with a pH of 7.22 (very bad) and a pO2 of 7 on 15L of O2 (very bad). Erk. Bleeped on call surgical SHO immediately.
He came to see the patient and meanwhile I was called to see a patient with a blood pressure of 211/130 (very high). Now, low BP I know roughly what to do with, acutely high BP is not something I had ever come across on my own. I ascertained that this chap's epidural had been stopped that morning, and he had only just been restarted on his antihypertensive meds that morning. He was feeling sick and in pain and I reasoned that his BP was probably high due to pain and the stopping of the epidural (epidurals lower blood pressure by causing vasodilation).
Having discussed the patient with my surgical SHO, prescribed further analgesia and antiemetics I gave him some GTN spray sublingually and 5mg additional amlodipine and his BP came down beautifully to 130 systolic and he looked much better by the time I left. Even managed to leave roughly on time.
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