Critical Heat

I had some very ill patients today that should not have been in the general emergency section I was working in.

Lady #1 had a blood-glucose level of 35mg/dl. Normal is 70-100mg/dl. At such a low number, she could go into seizures or coma, so we kept a very close eye on her.

Lady #2 had uncontrolled diabetes and a critical high glucose that the meter could not read. She was still "CRITICAL HIGH-NOTIFY NURSE" 4 hours later when I checked again.

But my most worrisome was a middle-aged man, Mr. HMH (Huge medical history). Mr. HMH could barely speak; when he did, it was in a high, whiny, breathless voice. Noticeably weak, he could barely lift his arm for me to wrap a blood pressure cuff around him. His pressure was 80/50, much too low because he kept nodding off with his eyes wide open. Because his skin felt hot, I fetched a rectal thermometer. As the nurse rolled him over, I pulled down the diaper and saw a large stool stuck in the rectum. We also found a bedsore that was unknown to us before. We tried to clean the stool, but soon found that he was completely and deeply compacted with feces. Then, we unwrapped the dressing and found an advanced stage bedsore (http://en.wikipedia.org/wiki/Bedsore) with tunneling into the wound. Ouch! His rectal temperature was 100.0degF, so he had a low-grade fever. When I asked him his pain level 1-10, 10 being the worst you've ever felt, he replied 10.

"Where is your pain, sir?"

"Everywhere."

"Is there anywhere that hurts the worst?"

"My butt."

"Can we roll you off your sore? Maybe that will help."
"Yes, please."

With shaking hands, he held onto the railing and I stuffed a pillow under him to take pressure off his hip.

"Is that better?"
"Yes, thank you, thank you."

"Ok, is there anything else I can do for you?"
"Can I see your arm?"

"...Sure." I handed him my arm. He held it slowly to his lips and kissed it, murmuring, "God bless you. Thank you."

I felt tears spring to my eyes. I patted him a few times on the shoulder. Later, I brought him some orange juice with a straw, that he drank slowly. It must be a terrible experience to be sitting in a stiff stretcher for 10 hours with nothing to eat and not being allowed to move around much.

And then they pulled me out to sit with combative drunks, one of whom told me "you're too nice to live in this country"- thanks buddy... but that's a story for another day. I went to my ER for a ceremony this morning. Upon seeing me, I was recruited to come into work early. It will be a veeery long shift- I know it already. At least I cajoled the charge nurse to switch me out of the drunk tank tonight. :-)

S