Our hospital has been running "at capacity" for over a week now. Too many sick, just barely enough room. We're holding people in the ER for 18+ hours because of a lack of beds.
We admitted a 11 year old *** a couple days ago from an MVA with major head trauma early in the morning. He is is too unstable for any of the junior staff to handle (pretty much all we had that night) and he had respiratory arrest when they put him on the x-ray plate.
I get report.
He was an unrestrained front seat passenger in a T-bone at highway speeds, and his ****** was DOA. Custody is with the paternal grandmother but the **** were with the ****** in her car; she has facial and scalp lacs and a ***** concussion. His **** Scale is 3, he has gray matter flowing from his nose and an open temporal fracture and Spinal Fluid from his ears; his left tib-fib compound fracture is back-slabbed and ********, they haven't really assessed for any other injuries since his head is so broken, Heart rate is 145, BP is 70/40 on 0.9 of epi and 0.8 of norepi, and he's had 3 L of fluid. His temp which had been 28C was now 38C and he was in respiratory distress... very agonised breathing. We jack the pressors up to 1 mcg/kg/min of each. I culture him up and give him his first dose of abx. After confering with the attending over the neuro status of the patient we decide we are going to take the ****** to the quiet room.
The rumor is that *** and Grandma **** each other and could come to blows... The room is packed. Despite being given a complete and accurate picture of his chances of survival, the ****** refuses to consider withdrawal.
I spend the night double-pumping pressors, giving fluid boluses, cleaning up gray matter, CSF and ***** and trying to be as blunt but as gentle as I can with the ******.
Fast forward to last night. The *** is still breathing in the 70's but appears to be withdrawing to pain. His heart is young and strong and hasn't given up yet. His kidneys have packed it in, with a CK of 140,000 5 days post injury and a serum K+ ranging 6 to 8.4... he's still on 1 mcg of epi and norepi, his cumulative fluid balance is 18 L, he's black to the knee on the left where he has the fractures and it smells horrible, his right foot is black to the ankle and all his fingertips are purply-blue, his gray matter is still oozing from every orifice, he has myoclonic jerks, fasciculations and tetany that the ****** perceive as him responding to them, a flat EEG. He has ST depression, inverted T waves, prolonged PR interval and maybe U waves on his ECG, with no variability in heart rate, persistently 140-146 regardless of what I'm doing to him. The night before, he had several runs of SVT, and prolonged hypotension. I'm no longer double pumping my pressors. The insulin, D25 and Kayexalate are keeping his K+ around 6.
The ****** asked me about dialysis. Yeah, right! They read him Bible stories and sing to him; someone (often many someones are) at the bedside all night.
For fucks sakes! He smells dead.
I want to shake that ****** and scream!
Staff (including myself) very depressed. Our hands are tied.
Do not look forward to work tonight...
Sorry for the vent!
We admitted a 11 year old *** a couple days ago from an MVA with major head trauma early in the morning. He is is too unstable for any of the junior staff to handle (pretty much all we had that night) and he had respiratory arrest when they put him on the x-ray plate.
I get report.
He was an unrestrained front seat passenger in a T-bone at highway speeds, and his ****** was DOA. Custody is with the paternal grandmother but the **** were with the ****** in her car; she has facial and scalp lacs and a ***** concussion. His **** Scale is 3, he has gray matter flowing from his nose and an open temporal fracture and Spinal Fluid from his ears; his left tib-fib compound fracture is back-slabbed and ********, they haven't really assessed for any other injuries since his head is so broken, Heart rate is 145, BP is 70/40 on 0.9 of epi and 0.8 of norepi, and he's had 3 L of fluid. His temp which had been 28C was now 38C and he was in respiratory distress... very agonised breathing. We jack the pressors up to 1 mcg/kg/min of each. I culture him up and give him his first dose of abx. After confering with the attending over the neuro status of the patient we decide we are going to take the ****** to the quiet room.
The rumor is that *** and Grandma **** each other and could come to blows... The room is packed. Despite being given a complete and accurate picture of his chances of survival, the ****** refuses to consider withdrawal.
I spend the night double-pumping pressors, giving fluid boluses, cleaning up gray matter, CSF and ***** and trying to be as blunt but as gentle as I can with the ******.
Fast forward to last night. The *** is still breathing in the 70's but appears to be withdrawing to pain. His heart is young and strong and hasn't given up yet. His kidneys have packed it in, with a CK of 140,000 5 days post injury and a serum K+ ranging 6 to 8.4... he's still on 1 mcg of epi and norepi, his cumulative fluid balance is 18 L, he's black to the knee on the left where he has the fractures and it smells horrible, his right foot is black to the ankle and all his fingertips are purply-blue, his gray matter is still oozing from every orifice, he has myoclonic jerks, fasciculations and tetany that the ****** perceive as him responding to them, a flat EEG. He has ST depression, inverted T waves, prolonged PR interval and maybe U waves on his ECG, with no variability in heart rate, persistently 140-146 regardless of what I'm doing to him. The night before, he had several runs of SVT, and prolonged hypotension. I'm no longer double pumping my pressors. The insulin, D25 and Kayexalate are keeping his K+ around 6.
The ****** asked me about dialysis. Yeah, right! They read him Bible stories and sing to him; someone (often many someones are) at the bedside all night.
For fucks sakes! He smells dead.
I want to shake that ****** and scream!
Staff (including myself) very depressed. Our hands are tied.
Do not look forward to work tonight...
Sorry for the vent!
