Saturday, September 09, 2006

Funky Neuroleptic Malignant Soup

I’m off today. Yippee!!! Last night I was made to look after a very interesting case. It is not often that we have psyche patients in the unit, unless of course you count those that OD’d [overdosed] on some bizarre mix of whatever tablets they found in their toilet cupboards and those that fiddled and got carried away with whatever vegetable they found in the kitchen fridge.

This one is really catatonic schizoid and was sectioned 5(2) which translates to being actually legally restrained and detained in hospital when deemed necessary by the medic as sanctioned by the UK Mental Health Act. I thought, this is going to be very exciting – although, after a rethink I wondered why do I always get a sick patient? I know, patients come to ICU when they are really, really sick but I was also thinking along figurative lines like: Yeah, let him deal with an antisocial mind and of course, violence. I can sense a bit of sexism in the allocation as I am the only male staff, but I can understand as this chap is really ‘huge’. Not a politically correct choice of word, but this one really tipped the scales and the bed.

I wasn’t really convinced that he was a proper ICU candidate looking at the working diagnosis from the wards. It’s quiet often that those patients go to ICU because they are physically rather than medically demanding. I don’t mean to slag off the colleagues from the wards because I know they are really hard working and understaffed, but it’s quiet funny to see patients that you have just attached to wires and monitors one minute and then offered tea and newspaper the next. They are not on an aeroplane, and definitely not in business class. It is ICU for crying out loud, and it’s an absolute waste of hospital resources.

Looking at his notes:

Query CVA [ Stroke ] – found in dumpster / skip , not responsive, GCS 12/15. I thought: Oh, okay. But also, he is catatonic and he is psychotic.

Query Septic, UTI smell. – I wasn’t sure if I’ve read this correctly, but this was in the medical notes. Honestly. And I thought, wow. If you happen to have this wonderful sense of diagnostic olfactory skill, think of the hospital money that can be saved.

Who needs that lonely git with the Petri dish and culture bottles in that sad cubbyhole called the lab when you can go round the park and sit beside a group of greasy ragbags that stank of horse piss then tell them:

“Oi! You mingin’ little bastards take a couple of tetracycline three times a day because you lot got a urinary tract infection.”

Query Neuroleptic Malignant Syndrome, on Quetiapine , Amesulpride – Very fancy and had no idea of it to be honest. Mental note: Will Google the damn thing as soon as all admission paperworks are out of the way.

Past Medical History- Stroke a few years back. Old CT Scan, showed Lacunar Infarct.

Outstanding problem:

Elimination – Not peed since morning. Massive bleed from urethra. I was told that they tried to insert catheter in the ward but failed miserably. Had a look and it appeared that meatus is very, very small. Managed to insert size 10 catheter and blood flowed instead of wee. Did bladder washouts but clots seemed to block passage. Wondered if they rammed this poor man's tackle with a 12 gauge shotgun instead of Foley's invention. In the end, Doctor inserted Suprapubic Catheter – And ouch! This procedure is not for the squeamish. Made sure relative is tucked away in a corner in case there are outbursts of ‘unprintable’ language. He did a portable bladder scan then stabbed the poor chap’s tummy with the tube. I would say, it worked really lovely. Urine flowed. Well done.

Overnight, respirations and gas exchange have been monitored. Kept an eye for hypoxemia and acidosis. Intubation set kept at bedside. Monitored temperature and ECG for arrhythmias. Full blood work including CPK, liver and thyroid function. Hourly neuro observations.

By morning, patient remained stable. There were discussions of lumbar puncture to rule out CNS infection, but I was already looking forward to ravage this nasty but highly nutritious miso.

graveyard. inertia of the body. runs. counter to. cerebral. paralysis. agression sublimated. brought deep. introspection. vagrant matter. exhumed. the abyss. where. time is just a concept. the spirits. meandering. gave the illusion. of coming back. on exactly the. same temporal length of event. i screamed to ascertain. its reality.



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7:21 PM  
Blogger HILLBLOGGER & Hillblogger Jr said...


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5:23 AM  

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