Friday, April 22, 2005

I believe that imagination is stronger than knowledge;
That myth is more potent than history.
I believe that dreams are more powerful than facts;
That hope always triumphs over experience;
That laughter is the only cure for grief.
And I believe that love is stronger than death.
~Robert Fulghum
Something I read in one of the books of my favourite authors. For some reason, those words stuck in my head.
It was a busy call last night. Challenging, in terms of difficult patients, as well as the politics of medicine. The ER gave me a hard time yesterday. Dr. V, an ER consultant we all have come to fear because of his low threshold to admit people, was working the night shift. And so, I got vook-ed (word we use when we get screwed by Dr. V) several times by him with some really soft admissions that really were stable enough for the regular floor. The problem was, last night we simply ran out of beds. Yes, the Medical ICU ran out of beds, all 24 of them.
So, I had to shut the place down. Called triage and said we were no longer admitting and patients would overflow into the other ICUs.
At 630am this morning, they tried to admit a patient who was septic. And because of the overflow, the patient went to the cardiac ICU. And coded not long after she got there. The story I heard, was very septic patient, who went into v-tac after she perf-ed her bowel. And the cardiologists, though their efforts valiant, were just in way over their heads. After all, they were used to treating cardiogenic shock, myocardial infarcts, but not regular sepsis. The patient died.
It gets me mad though, because this patient clearly should have come to us. Not that we could have made a big difference in outcome, because if you decide to perforate your bowel and spew gut content into your belly, you better darn well have some strong antibiotics and a good surgeon nearby. But we probably would have had a higher chance of saving her.
But, because of the system, proper triaging was not enforced and our beds were taken by patients who didn't need to be there.
Like I said, challenging night. I get the rest of the weekend off. 2 more calls left! Looking forward to watching the Formula 1 race in San Marino this weekend. Haven't had the chance to watch any races yet this season.


Anonymous huajern said...

Wouldnt Surgical ICU be more appropriate?

3:57 AM  
Blogger vagus said...

The perf occurred 4 hours after the patient arrived. So she could have been treated in the Medical or Surgical ICU initially.
She was septic and hypotensive, has some elevations in her lactate and probably has some bowel ischemia going on from the septic shock. Unfortunately the choice of pressor was phenylephrine which probably worsened the bowel ischemia and facilitated the perf.

7:19 AM  

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