Archive | December, 2007

Abdominal Compartment Syndrome

26 Dec

Another sad episode.

It was another one of those days with 6 patients–

One of those patients was morbidly obese that came to the hospital with shortness of breath and increased weight gain and was diagnosed with congestive heart failure. The only past medical history was of thyroid in nature.

The patient had exophthalmos of which I had never seen the likes of before besides in a text book.  

The day I cared for this patient was perhaps the 4rth of 5th day in the hospital: and that is when an acute change in mental status occured and I had no idea what was wrong with this patient.

This patient had a gastroenterologist–a pulmonary doc- and was admitted under a cardiologist care–

At some point perhaps day 2 of this hospital admission the patient had an abdominal ultrasound which showed a large amount of ascites in the abdomen.

The abdomen just looked obese to me.

During my morning assessment I noticed that the patient was repeating the same sentences often–almost fixating.

In report I was told that the patient was alert and orientated.

I asked the patient who the president of the US was–the reply was Tuesday and I can not lay down to have a ct scan done.

There was a definite change in mental status.

So the attending Cardiologist asked for a neurologist to see the pt–but the pt could not lay down for a ct scan and the neurologist left.

I called the house doctor as 6pm–because the patient started to climb into bed with the roommate. The mentation was declining.

ABGs revealed that the pt was slightly hypoxic–

Finally the night time house MD transferred the patient to the ICU–by the time the bed was available it was 9pm–

at 10pm the patient suffered a cardiac arrest and was coded and intubated which was extremely difficult.

There was no room to breath. While I am in complete understanding that in an acute care setting things are not always stable–but I just can not help not feeling good. I also understand that the patient that is so obese can be complicated medically.

What I learned.

1. If I do not feel good about the situation just keep asking for help–it took from 10am till 7pm when the night house MD transfered the patient.  I kept calling MDs all day–but I did not know what to say–except “something is not right with the patient.”

2. Stop and pay more attention to the morbidly obese because the risk is so high for these patients.

3. Abdominal Compartment Syndrome-There was no room for this patient to breath. The abdomen was large (I thought it was the obesity)

4. The patient was transfered to the unit and was being worked up for sepsis–

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Not feeling so rosy

22 Dec

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The truth is I have not been writing much lately. I have just been down in the dumps lately!  I suppose it is just that most wonderful time of the year or something else I can not exactly define. It is the job–and leaving the job feeling like something was not right or something was not done or just something. And the good old trying to make everyone happy business.  I even joined the gym!  I never go because I felt like a mouse in a cage on one of those exercise wheels.

I even cried at work again as usual towards the end of the day—and I could not help it the tears just sprouted out and would not stop and I looked like a big baby–That has to stop.