Code blue, level 0, Diagnostic Imaging.
Code blue, level 0,
Diagnostic Imaging.
Morning guys. I'm Siobhan, a 3rd year medical resident.
It's Saturday morning and I'm just getting to the hospital to start a 24-hour call shift.
So I have no idea what's going to be coming our way.
Seeing emergencies, seeing patients in the emergency department, up on the ward who are already admitted.
We'll see what happens.
Okay, so we just met as a team. Today it's
myself, another resident and an attending physician. We've got like 24-ish patients on the list,
so we're each seeing about 7 or 8 people today.
And that's the plan. We go see all of our patients, see what comes up, who's sickest, what needs to get done, any procedures.
And then when all that's done, we'll meet up and talk about all the patients together. So let's go and do that!
Oh and in case you're wondering: No that's not a picture of a
monster back there, it's actually part of the kidneys. We're teaching about kidneys earlier.
I just saw it in the background.
After spending some time this morning reviewing bloodwork and looking at notes in the chart, I finally go and see the patient.
He's a 62 year old man who has end-stage liver disease from alcohol use.
Even though he quit drinking 6 months ago, the damage to his liver is
irreversible, so he's waiting on the transplant list.
He tells me that the last couple of days his
abdomen is getting more and more uncomfortable and it's really hard for him to walk.
I examine him and find that his abdomen is huge, even though the rest of his body is really skinny.
I can tell that it's a buildup of fluid from the liver failure.
He tells me that this has happened in the past and that he's had fluid drained out of it and I agree.
It's time to drain out more fluid again.
Okay, so we're done seeing all of our patients and we just met as a team.
So now time for some food and then let's go and do that paracentesis
on the patient with the distended abdomen.
I think he's gonna feel so much better when we can drain out some fluid from his belly and especially before things get busy down in
the emergency department.
So the fluid is all around the organs in the abdomen, not actually in the bowels.
So imagine that the organs are kind of floating in the fluid and the goal is to stick a needle in and drain it out
without hitting any of those organs.
So I use an ultrasound to find a safe place away from the bowels.
I freeze the skin with lidocaine and then insert the catheter.
I'm relieved to see that the fluid coming out looks normal, yellow, clear. It doesn't look like pus or blood.
And then it's really just a waiting game, waiting as liters of fluid drain into a pressurized container.
Then we only send off a small sample to the lab looking for signs of infection and the rest just gets thrown out into
biomedical waste bins. And that's it.
So the paracentesis went really well, we drained off almost 5 liters of fluid. He's definitely feeling this way better.
Now I'm gonna quickly run downstairs and get myself a call room key, try to get one of the good rooms.
The little things when you're on call.
Oh man... Great room, but it is so
incredibly hot in here. Like I mean... If I have a chance to sleep,
I don't know if it's gonna be possible. I should have gotten my call room key earlier in the day. Ah, I'm having some serious regrets.
Okay, let's see what we can do with this thermostat. Oh man, this is so bad. It's as hot as it could possibly get and
it's already been adjusted all the way down and it's not responding. Oh my gosh!
Okay, don't worry. I do realize that I'm in the hospital and people are having a worse day than me.
And they worse problems than having a really hot room, but still...
It is not my favorite moment.
But even in a hot room
I am so happy to be able to put my feet up
and get comfy.
* Pager goes off *
Oh man, I spoke too soon. Let's see what this page is about.
Hi, this is Siobhan from team A returning a page.
What's the patient's name?
Yeah, of course. I'll be there to see him really soon. Okay.
Thanks very much. Okay, I'll give you a call after. Okay, bye.
Okay, so that was one of the surgeons. It sounds like one of their patients
just had a CT scan of their chest and it showed a pulmonary embolism, so a blood clot to their lungs.
And they are basically asking us to come and see them and help make a recommendation for treatment of the blood clot.
So let's first go and see how the patient is actually doing.
I never thought I'd feel so relieved leaving my call room. Like it's so hot in there. I'm actually feeling like I'm coming alive again.
Do you see how red my cheeks are?! My goodness.
Anyway, when I'm going to go see a patient, I always like to think about
the emergencies. What do I not want to miss and what's my plan when I'm actually seeing them.
So in this case if the patient is very unstable,
blood pressure is low and really not doing well, then you actually think about giving a clot buster.
I don't think that's the case here.
Otherwise, it's mainly: Do we give a blood thinner when somebody has had surgery or not?! So that will be the decision today.
Hey, this is Siobhan getting back to you. I just wanted to touch base with you and see if
you felt comfortable having anticoagulation starting today. Okay, perfect.
Yeah, that's actually what my staff was thinking as well.
Okay, so if you're okay with it, I can just put in the orders and we'll follow up with him tomorrow as well.
Okay, fantastic. Thanks so much. Okay, bye.
Okay, that worked out well.
Sometimes it's just... It's so nice to pick up the phone and actually talk to someone rather than just writing notes from the computer and
you don't know who's reading them. Like that level of communication makes the hospital feel like a smaller place.
Alright, here we go. Things are getting busy in the emergency department.
Okay, it's 3:00 in the morning,
3:15 and I have just completely hit a wall of fatigue. Like I'm cold and I just feel like struggling.
I just finished 4 consults from the emerge back to back.
I know, I was gonna try to get a little bit of rest.
Now I'm looking forward to my really warm call room, because it was so cold in the emerge. It just kinda keeps me happy,
especially when I'm tired in the middle of the night, like my body temperature is obviously all off.
Yeah, so I admitted a patient with heart failure, with pneumonia, one that
I'm not quite sure what was going on. I think it might be a new diagnosis of metastatic cancer.
And one of the... That I'm already forgetting.
Who is that?
Oh, a patient with opioid withdrawal.
So lots of things, I'm gonna tell you all about them. But let me just go be able to rest now.
* Pager goes off *
Code blue, level 0, Diagnostic Imaging.
Arriving at the code blue, there's at least 20 people in the room already.
My resident colleague is already running the code.
So I find out what I can do to help.
I grab a computer and start looking up recent bloodwork and imaging to help figure out what caused the cardiac arrest.
I can see the patient's kidneys have been failing and his potassium has been increasing rapidly.
Passing this information along, we treat the patient by giving calcium gluconate to stabilize the heart cells and
insulin to shift potassium into the cells.
The nurses managed to get blood work and we send it out to the lab.
The patient also receives epinephrine along with chest compressions to help restart the heart and it works.
We still don't know how the patient's brain will recover, but for now he's alive.
So the patient is now getting wheeled down to the ICU and the rest of us sort of
just disperse and go back to what we were doing before.
Hi. Yeah, this is Siobhan from team A medicine.
Oh yeah, definitely.
Yeah, it's no problem. I can put in a Tylenol order.
Okay.
Okay. Thanks, bye.
Okay. A patient is in pain and the nurse was hoping to get a Tylenol order, so I just put that in now.
Wow.
S it's morning and it's amazing. I woke up with my
alarm just now rather than from another page.
So I was able to get a little bit of sleep at the end of the night which feels good, but it
sucks to wake up at this time. Like my body was just getting in the rhythm of sleeping.
But that is not the time.
I'm going to take a look at patients' morning blood work and then
going from the team to handover this morning. Tell them all about the last night.
Thanks so much for watching guys.
It's honestly more fun having you along with me on these call shifts and being able to tell you about them.
So I'm looking forward to seeing your commenting here and what you think. Let me know if you have any questions and otherwise,
I'll be chatting with you in the next video. So bye for now!