The lady with blue earlobes was not so much a difficult medical case as it was an opportunity for me to step up onto my “senior resident” ladder and pretend like I was smart.
It was one of my very busy overnight shifts and while I was in with another patient, medics rolled in a lady who was SOB (short of breath). She was placed in a curtained room and the intern went into see what was going on. I came back to the physicians desk and heard our monitors wildly beeping. I glanced up to see that there was a new patient in the heart room with a heart rate of over 150. She was gasping for air and the intern was taking signout from the medics.
A quick assessment was obvious for pulmonary edema, and with a heart rate that high, she was considered unstable. Her arms and legs were plumped up like ballpark sausages. She needed IV access no matter what route we chose, but none of our nurses could get a successful line started. We gave her sublingual morphine to unload some of the fluid from her lungs, paged respiratory for a bipap machine, and then attempted a femoral line.
Like I said, it wasn’t so much the medical aspects, as seeing my new (ish) role as an upper level in a new light. This was a learning experience for the intern, and I could see his fear and hesitancy. Normally there are 5 or 6 residents working and we don’t have a ton of direct intern involvement unless we create it. Night shift is different though, one intern, one senior and the attending (who may be “watching the news”)
The attending and I tag-teamed helpign him with the central line. The attending finally got the stick left handed, reaching across the patient (I was at the foot), and the intern did the rest. Once the line was in, I pushed 120mg of Lasix that the nurse had drawn up while simultaneously showing the intern the finer points of sewing in a centeral line so that 1) it doesn’t come out when it shouldn’t and 2) it comes out easily when it needs to!
Prior to the attending’s arrival, I gave the intern a quick speech about stat treatment for heart failure (nitro, morphine, bipap) that’s worth a try before sparking someone or intubating them. After all the flurry and line placement, the attending took the intern aside, and I heard him give the same speech that i had just given! Cool. Maybe I’m getting somewhere after all. I wonder if anyone will give me a job when I’m done here?