Wednesday, September 5, 2012

Broken Arrow

When you're on night duty, you carry at least one pager.  If the nurses need to contact you they can page you and you respond as fast as you can.  Or they could use the online message board which you check at your leisure and prioritise yourself.  In theory, the message board is for non urgent tasks, while the pager is for urgent things.  In practise, this does not occur.  I got a page the other day, to which I duly responded urgently, and the subsequent phone call went like this:

Hello - you just paged me, what's happening?

The man in bed 4 is having a hypo.

What's his blood glucose level?

We haven't done that yet.  He just said he feels funny.

I see.  Why don't you measure his blood glucose and call me back?
They did not call back.  So I went round to the ward, wondering if perhaps they were too busy resuscitating the guy to call me.  They were sitting casually at the desk,  I picked up the patient's chart and saw that his blood glucose five minutes prior to me being paged was 7.9.  I said nothing but waved the chart at the nurse with what I imagine was a look of gentle inquiry on my face.

Oh, it turns out we'd done it but I didn't know about it yet.
This is an exciting development in medicine.  I look forward to being paged urgently to manage hypotension for which no blood pressure has been taken, catastrophic haemorrhage with no bleeding, and syncope with no altered consciousness.


Anonymous said...

It is indeed an exciting development, do be wary. It happened to an esteemed colleague of mine who was called in a frenzy about an agitated patient, it sounded like they were about to do turn into a giant green rage monster and so they prescribed some benzodiazapines. However, the patient was actually rather small and very ill so while entirely encephalopathic and a bit of a jerk to boot was not likely to renovate the ward as it was suggested.
Also the time when they was highly agitated had well passed and was now sleeping peacefully and so the IV benzos pretty much stopped their breathing.

PTR said...

That is a quality anecdote which reinforces my opinion that most benzos are for treating nurse anxiety rather than patient anxiety.