I’ve had way too many sick (i.e. dead to near-dead) patients in the past few shifts.
1) Middle aged reclusive son brings in his dad who was “confused”. The patient is cyanotic, making agonal respirations, the son wants every thing done to help him. The patient responds only to obnoxious stimuli, and even then only with another agonal breath. Blood pressure non-existant, pulse 30. We start CPR, give him atropine, start 2 IV sites, push fluids. Intubate, give some epi. He develops bounding pulses over 100 beats per minute with blood pressure of over 100. I waltz out of the room triumphantly to go get more information from the son. I ask him what he was like on the ride over. “Well, he was sleeping on the way over.” Yeah right. He was busy dying on the way over. To make a long story short, he circled the drain too many times and I was only keeping him alive by pumping him full of epinephrine. We stopped and he quickly died. He had had a massive heart attack (His first troponin was over 3.0.
2) Drunk man brought in by 911 for “panic attack”. Ha. He was in anaphylaxis. Again, I pushed IV epi with minimal response to his airway. He had audible inspiratory stridor. He made small improvements and then would get worse. AFter I had given him over a milligram if IV epi, I decided that we needed to intubate. I knew it would be nightmarish so I called anesthesia down to be with me. The CRNA and the anesthesiologist showed up. He had the biggest epiglottis I’d ever seen with massive airway edema (but none in his oropharynx). I let the resident try and he failed. I was not in the mood to play hero, so I asked the CRNA to take a look. WIth difficulty and a 10 foot long Miller blade (OK, not that long, but it seemed like it), She got a 7.0 tube in. THe next day, he was an extubated, obnoxious drunk in withdrawal.
3) 1 1/2 year old boy with a bottle of (fancy fun smelling adult) shampoo dumped on his head by his brother. We had to sedate him in order to irrigate both eyes, and he had complete erosion of both corneal epithelium. He was in a lot of pain. I sent him to the big house across town.
There were probably others. I need about 3 weeks off.