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Wednesday, March 27, 2013

Just Another Gastroenteritis

This last fall and winter, we had a huge influx of patients with gastroenteritis, aka "stomach flu."  It seemed like three quarters of our peeps came in with nausea, vomiting, and abdominal pain.  It became pretty routine: Zofran, fluids, maybe something for pain, discharge with Zofran ODT script.

One lady came in who was maybe in her 50s with the same ol' symptoms.  So, what did we do?  Well, the plan was to do the same ol' thing we do for all of them.  However, this one was a really difficult stick.  I couldn't get it and neither could the charge nurse.

So, we gave her some IM meds and held out on the fluids, but the doc really wanted us to have IV access because he was pretty sure she was gonna need fluids.  Luckily, she felt better after the IM stuff and Dr. Discharge was getting ready to let her go.  When I went to do the discharge, though, her pain came back in the worst way and she started retching again.

I let the doc know.  Nothing was super out of whack on her labs and her xray showed a little bit of constipation, but the doc didn't think it was necessary to do a CT.  He ordered a repeat of the same IM meds we gave earlier.  Success!  Until I took her discharge papers in.  Same thing happened again.  Ordinarily, we'd say, "ok, lady, come on."  But she had no history of being in there or any other hospital that we could find.  So, doc gave her the benefit of the doubt.

This cycle of meds, then retching/pain went on one more time.  Finally, the doc said, and I quote, "Fuck it.  Let's just order the damn CT."

He wanted contrast, so we needed the IV.  But, like I said, she was a tough stick.  We had five different nurses try.  The doc tried with an ultrasound machine.  Nobody could stick this lady.  We don't have the benefit of a PICC team on night shift.  This poor lady kept getting stuck over and over and over.  Finally, one of the nurses asked for another shot, and she got it!  Away she went to CT.

In a little while, we got the results back. . . Ischemic Colitis. . . Oops!  Time for surgery!

1 comment:

  1. But when you hear hooves who looks for zebras?

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