Fight or Flight

I’m sitting on the sofa waiting for my uniforms to wash. I’ve given a new HCA two of my uniforms so I only have two sets left.

Last night was stooooped. I got to spend all night in resus with Dr Furnace, Sister Cat and Nursie Doll
A gent was brought in under police arrest; he was discharged and collapsed in the car park. He was competitive, aggressive, and not at all helpful. He had been in custody for 24hs and had been given insulin by the custody nurse. He then skipped his supper, and went hypo. Hence the combativeness. We got some glocogon into him and some 50% dextrose into a hastily inserted canula. He proceeded to rip it out spraying hep blood all over the nursing staff. Or mainly me. He came round and calmed down. I’d met him the night before and I thought we had a rapport. He spoke to me, but his eyes were a little wild. He went off to AMU.
Resus was quieting down, along with the rest the unit. When the call came in with a gent who was brady at 30. Dr Furnace and sister cat started the Obs. The brand new defib, that no one is quite shore how to use, was wired on. The ECG showed complete heart bock. He needed pacing. His heart stopped, sister cat sprung into action with a pre cordial thump. Starting his heart again, into a recognisable rhythm. Amazing. It’s the first time I’ve seen that properly. Cardiology came down and took him to the cath labs for a temporary wire.

While this was going on a hanging was brought in. He was on the scoop, his shoulders shrugging, barely maintaining his own airway, in went a guidel, to work in concert with the NP that the ambos put in. His clothes came off, my new shears slicing through his jeans like they were paper. ITU was summoned, lines put in and fluids hung. I struggled to write down the drugs that were given, when another code blue was announced in reception. All the trained staff were busy stopping those in resus dieing. I was sent with a triage nurse to find out what was going on. It was a drama queen ?anaplaxis who had thrown her self on the floor. We put her on a trolley and wheeled her to majors. Where she was discharged two hours later. I went back into resus to help with the hanging. (That probably sounds wrong). Sister sent me to deal with the wife. She was understandably distraught. I did my best. The patient went off to the donut. I stayed with the wife. Feeling very out of my depth trying to provide what comfort I could. He went strait to ITU. I took the tearful wife up too ITU to see her husband. A little while later the patient’s parents turned up. I took them up to ITU. It was all very tearful. I went down stairs to majors, and stocked up the blood trolleys and catch up on the paper work that I could not have done when I was out of resus.

A get was brought in GCS three, found on the floor in a popular sandwich bar. The ambos guiltily rolled him into resus. Where we demonstrated a *city deleted* roll for new Sho Island. The patient flopped on to the trolley. We cut his clothes off to check if he had been injured. No injuries. Extensive “stimulation” was applied to see if his GCS would come up. It did not. The patient started to reach, Dr Furnace heroically rolled him towards sister cat. His GCS came up a little. So we put a convine in. Inadvertently provoking a series of hysterical laughter. The only convine I could find was a pedantic one. My innocent comments of “it’s a small one” and “oops a paediatric one” sent stalwart professionals bomb bursting from resus in gales of laughter. What made my evening was when the gent woke up in majors, his comment was “Where are my clothes, and what the fuck is this on my willy”. I laughed.

Later another code blue came in, a young girl, in her twenties who had decided to jump off a balcony. 20+ feet. She had 10/10 lumbar pain and a ? Broken ankle. She was a bit tired, and more than a bit pissed. She was stable, and moved to majors. I’m sure I’ve met this girl before. But I’m not sure. Her neck was cleared, but her L-spine film showed “Coy Owls”. If you look at a lumbar x-ray you can see owls. (I’ll try and find a picture to demonstrate this). If they are winking at you, or being coy, then they are worth paying more attention too. As you would if you saw an owl winking at you. Sure enough she had two owls winking at us. One was a fracture straight through, and the other had a nice big chip off it. She was understandably in pain. She went up to the orthopods.

A gent was brought in fitting. He had a previous head injury leading to prolonged LOC 10/7 ago. He did not come to hospital at the time, as he did not want to waste our time. We got him sedated with some lorazapam, and summoned the ITU docs. He went down to the donut. And then strait to ITU. I think someone told me he was coning. Not a good thing.

While this gent was being dealt with I met a delightful gentleman. As Dr Furnace put it, in much relaxation. He had been smoking “Skunk Class A” almost constantly for the last 24hs. He was very very very aggressive. Alternating making unreasonable requests for “huge blunts” and “big TVs with GTA on it” to begging for help. He took exception to the fact that I’m “big boned” and was a little sweaty (ok more than a little, I’m built for arctic conditions). Shouted insults do not bother me. Dr Furnace got a line in, very carefully, and then wicked in a load of Madazolam. The violent gent went out like a light.

About an hour and a half later I wandered into resus, the bed he was on was empty, and Nursie doll was AWOL. I started to panic. She was not on the floor, I could not find her on the unit. I really started to panic. I found the idiot in the loo, but no sign of Nursie Doll, I then found her in resus, drawing up some madaz. I went back out to try and talk the idiot back to resus. He decided to take exception to two relatives with the gent with the HI, I stood in the way. Inadvertently dropping into my “I’m going to grab your throat and punch you in the face, if you give me cause” stance (my history as a professional idiot). Not the best idea in a hospital. Usually at work my adrenaline gets going when we are at an arrest or a critically ill patient. In this case my “fight” mechanism was going over time. I really wanted to illegal things to this gent. Luckily Dr Furnace got the happy juice in, and the idiot went down like a sack of spuds. Psyche would not come and review him, as we had chemically sedated him and he was un-acessable, the medics would not take him, understandably. This guy on the admissions ward would not be a good thing. He needed to be in a psyche unit.

He began to wake up again just before I went home, more madaz went in and down he went. I hope he was ok for the day girls.

The last patient was a very present young lady who put up with our less than lucid conversation as we pulled her collies fracture. I’m very impressed with her. She took our inane conversation with good grace, and did not even swear at us as we moved her wrist. Broken wrist girl, I salute you.