When the director of the department stands at the desk, looking down the hallway watching the helicopter crew wheel a sick patient in…and he looks directly at the two second year residents (me) sitting behind the desk and says, “They’re bringing in a pretty sick patient right now,” …it’s generally a good idea to get up and go see the patient.
I’ll take “sick patient” over “abdominal pain” any day.
He was right, this guy was sick. Leukemia, bone marrow transplant, short of breath, hypotensive (65/35). Clinically in heart failure. Was he also septic? I called for a bipap machine hoping I could avoid intubating him. I started him on dopamine for his blood pressure. We got a portable chest x-ray. I had started all of this before the attending came in (but I’m sure he was lurking outside the room). In the meantime, the senior resident came in and asked me if I wanted her to take the case. Part of me wanted to say “Yes, Please!” but I knew that if I couldn’t handle the challange, the director wouldn’t have let me walk in to assess him in the first place.
Well, he was really sick. He had an enlarged heart, he was on three pressor medications and finally, I intubated him. It was a challanging intubation as well, a little bit scary in fact. Although it was an ‘elective’ intubation in that he was stable on bipap, once the sedative agent hit, he went apneic and his sats dropped far lower than I like to see while trying to “tube” someone. I called our intensivist, presented the patient while he quietly listened and then said, “we’ll have a bed for him in a little while.” He came down to see him and approved of everything we’d done so far, which made me feel pretty good.
The patient was doing pretty well, considering that we had no idea why he was sick. His oxygenation improved on the ventilator, he had antibiotics running, his blood pressure came up a little bit. I transported him up to the ICU with the nurses and gave report to the residents there. Tomorrow I’ll stop up to see what’s going on and if they’ve found anything yet.