Monday, January 31, 2005

Night Shift Australia Day

Just finished two nights and I can't sleep yet.

Nights were good. I'm too tired to write straight, so here is a brief precis of what we had Friday and Saturday nights.

10: 02 - Pool cue versus head. This was a twenty four year old man who was minding his own business when for no reason, some guy smacked him in the head with a pool cue. He needed six stitches and because you can't get local anaesthetic into the ear (there's no stretchy skin over the ear, like there isn't over the nose or the heel) we had to do a nerve block. This is not an arcane kung fu technique, it involves injecting the local anaesethetic somewhere "upstream" from the actual area you want to anaesthetise and numbing the whole area. If you want to anaesthetise the ear, you inject at four places, sortof in front and behind, above and below, slowly, with a small needle, and the pain goes away for five to ten minutes - long enough to stitch things together. You can inject in a certain place in the hand and knock out sensation to a finger, you can inject in a wrist and knock out half the hand, etc.

Anyway, six very fiddly stitches and a tetanus shot and he went out to fight another day.

I didn't ask about the guy. It's always some guy who attacks people for no reason, usually young drunken men who are amiably minding their own business when this loon attacks them. If the police could just stop this one guy, then assaults in the southern suburbs would drop by ninety percent.

11:12 - Girl, stepped in barbeque.
This was horrible. Burns really really hurt. I got a line in and we poured in the morphine, and she was still crying half an hour later. This is almost the only time I have a problem with some nursing practice. Some of the older nurses - and some of the doctors, too - seem to have a problem with handing out the morphine. Not the newer ones, and the training now is to give as much pain relief as can be given safely, and give it quickly. With burns it's actually getting the dressing on and the cool water that seems to help as much as the opiates anyway. But the opiates are important, because the pain is excruciating.

I think some staff worry about creating heroin addicts. Heroin addiction is a big problem, but you don't end up smacking out grannies and robbing servos because we gave you morphine when you stood barefoot on hot coals. Pain is an emergency.

Anyway, all significant burns go up the road to the Royal, and that's where this girl went when the ambulance came.

00:22 Stuck my head in a cubicle to tell a thirty eight year old man (smokes thirty a day, one hundred and forty kilos) that his second blood test has come back, it's not a heart attack this time, go to his local doctor within the next day or so to organise further tests, start on an aspirin a day.

It is a weird feeling telling people my age that they are at risk of heart attacks. The youngest MI (myocardial infarction, exact same thing) I have ever seen was a twenty one year old man who dropped dead in the car park in the shopping centre across the road a few years back. We got his heart going, but not for long - I still remember the jolt, the green line that showed a few brave, normal looking beats, then the useless fluttering of his shocked and dying heart.

He had every risk factor available - Samoan, big, smoked three packs a day at twenty one, uncontrolled diabetes, drank, didn't have a living relative over forty. But Jesus, twenty one. We worked until the retrieval team from the Royal came, and then they called the death. I remember pulling off my gloves and going to answer a phone call from a relative. It was his sister and she was asking if he'd be home by six thirty because otherwise she had to pick up the kids.

Anyway, I'm getting morbid and I'm falling asleep at the keyboard here. More in the next few days.



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