Learned Something New This Week

I've been working quite a few shifts in the ER lately. I love it (mostly) and I hate it. I like the excitement and adrenalin, the Forest Gump box of chocolates theory works well to explain my days, I hate giving puffers. On the wards, puffers are a nursing job (or for competent patients, an independant job), of course, I'm happy to share all the workload with the nurses, I have a special place in my heart for nurses (they work SO hard!)... but seriously - puffers??? There are one million (at least 30) RN's working in the ER and 2 RT's.



I was called to a bed in Bblock of ER (aka "bad" block - for the sick patients - but better than Fblock for the "f***'d patients - I didn't make that up, but it explains it well - padded rooms, need I say more?). They needed me to run a venous gas (probably means nothing to the majority of those reading this). When I got there, the patient looked completely emaciated, basically on death's doorstep, and quite young (30's maybe). The results of the gas were this: pH6.8, PaCO2 9mmHg, PaO2 90 mmHg, HCO3- unmearsurable. Again, what this probably means to you is nothing. What this means to me is a not compatible with life metabolic acidosis. Turns out this poor soul had DKA (diabetic Ketoacidosis), which in nonmedical terms sucks. A few hours later "patient raging acidosis" was turning around thanks to rapid fluid rescusitation, however nurses were unable to get venous blood so I was called for an arterial poke. These pokes hurt. A lot. The follow up arterial gas was still dangerously acidotic, however "patient skin and bones" had reached capacity to sustain life, so things were looking up. While chatting over me jamming an 18 gauge syringe in to the radial artery and awaiting my 1 ML of blood that was perfusing way slower than I wanted thanks to basically no blood pressure, we had a nice chat. I was wondering how a young healthy individual gets a massive DKA attack (not that I asked), but apparently the patient was wondering the same thing. HOWEVER - what I did learn from "patient-I-have-been-in-your-room-entirely-way-too-long" is that it is completely normal (in fact, common) for people training for a 10 km race to lose 30 lbs in one month and pee about 15 liters a day. Are you serious? Umm... what kind of running do you do?



On a totally seperate note: Today's run was 32 km, 2hr 48min, 5:25 min/km, -17 degreesC, fresh snow and ice followed by a 15:00-23:30 shift. Gearing up for a much needed cutback of hours over Christmas (cut back from 60 hours to about 30 for 3 weeks) and planning to get some quality time in with my new running shoes.

In honor of my favorite nurse: If you ever need a puffer - I will give it to you with the best MDI and Spacer technique that I know! In return, if I ever have urine retention, you are the only one who can place a catheter in my urethra.