Tuesday, December 25, 2007

Silent Night

I spent the day at the hospital.  I took a call day so that everyone else could leave and enjoy their Christmas Day.  I called my mom mid-morning and got the report from the night before.  She enjoyed the gifts I had sent, and the extra special basket of sugar-free goodies from my fiance.

All in all it was a nice, dare I say, quiet day in the CCU.  I had one admission, and one sort of excitement toward the end of the day.  For the most part, I had about five hours of watching a CSI marathon and almost all of "Goldeneye" uninterrupted.  Mmmm, Pierce Brosnan as James Bond.  I could just watch him all day long.  For me, there is no more perfect Bond.  But, I digress.

If you've followed my prior posts, I think by now we've established some of the rules to follow when it comes to drinking.  Something I don't think has come up to this point, mostly because I see people in the ED once and not for several days in a row, is the discussion about what happens to people when they drink excessively for days and weeks and months on end and then come to the hospital where they're not allowed to drink:  a little something known as the DT's.

You're ok for the first couple of days.  Normal for the most part.  Then around day 3 you start to get a little anxious.  Maybe, a little more irritable.  Your heart rate starts going up and your blood pressure might go up as well.  Then the fun starts.  You start imagining things that aren't there.  You get confused.  You might even get physically argumentative.  If your medical team is unaware of your alcohol intake (and granted most patients lie when it comes to alcohol consumption which is why as a general rule since med school we've been taught to double anything the patient states is the amount of alcohol they admit to consuming), you might get placed on thiamine and folate and some Ativan (Lorazepam) to help you avoid the mental confusion aspect part.  When you start having seizures, that's a bad thing, and you could actually die (so admit to drinking alcohol and how much.  Please.)

If they don't, and you lied (of course you did) about the amount of alcohol you consume, you can go into full blown DT's (delirium tremens) which includes shakiness, severe mental status changes, lethargy, etc. and end up like my patient who is now on a ventilator after he became somnulent to the point he couldn't remember to breathe.  He would barely breathe when we shook him or called his name, but then he would go off into a stupor.  So, now he's got a breathing tube.  His girlfriend called later, and I had to tell her that he was on a breathing tube.  I couldn't tell her why though, there's this thing called HIPPA which is basically a patient rights document that states your medical information can't be shared with anyone not directly involved in your care.  I am sure she would tell me how much he actually drinks... if only I could ask her...

Some shots of downtown Buffalo.  I love the city, especially at night.  Merry Christmas to all!

CCU Countdown:
Days until the end of the rotation:  12
Actual number of days I will be working during that time: 11
Days left until the painful attending returns:  5
Number of days until my next 24 hours off:  11 (I am taking the very last day of the rotation off, so it's going to be a while, but worth it in the end.)
Number of short call shifts remaining: 1
Number of long call shifts remaining: 1
Number of patients: 4
Number of super nurses in the unit:  4
Number of evil nurses in the unit: 3
Number of evil Internal Medicine residents: 3 1/2 (1/2 because I like the one I took call with the other day, but he stole one of my procedures)

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