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OldPsychDoc runs a code

Discussion in 'Psychiatry' started by OldPsychDoc, Nov 22, 2005.

  1. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    OK, so the patient was LittleMissPsychDoc's hamster--but it survived long enough to make it to the "unit".

    I was summoned to LMPDs room with a concern that said rodent was dead. Physical exam revealed weak vital signs, shallow respirations, but very poor responsiveness. (GCS maybe 5, just a guess...) Subject makes no effort to right self when placed on back. Based on my clinical judgment that a veterinary consultation would be needlessly costly (as well as humiliating to OPD), an attempt at resuscitation was inititated. Patient was gently warmed with body heat, massaged vigorously, and administered sucrose solution via dropper. Patient responded to latter with vigorous sucking, accepted 5-10 mls of solution and rose unsteadily to 4 limbs. Later appeared to be ambulating normally, accepting light meal, and initiating po hydration. Nocturnal activity was reported by LMPD.

    24 hours later however, the patient was found obtunded in its living quarters. Respirations shallow and agonal. Nares and extremities dusky in color. Oral rehydration was again offered, but patient did not respond. Subsequent check 3 hours later revealed patient in fetal position in its feeding dish, negative vital signs, noticable rigor.

    Ah well---you know that most of these codes just do not end well...

    Now to my more experienced role as a grief counselor... :(
     
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  3. mosche

    mosche Senior Member
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    OPD, sorry to hear the news. Remember, these things happen for a reason, and your patient is in a better place. Right now it's hard to imagine, but this pain will pass. If you need someone to talk to, I'm here.
     
  4. Anasazi23

    Anasazi23 Your Digital Ruler
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    The patient clearly needed access and likely a pressor. Did you try to place a femoral? I took the liberty of reviewing the pt.'s chart before it made it to records. (BTW, I was asked to remind you to come down to sign the certificate. The night float said it was your job since you were the primary). I reviewed the pt.'s chart and found that you performed an ABG with the following results:
    7.10/70/34/21/59%

    I assume the hamster was intubated at this point?
    Since his bicarb is so low, the patient clearly had more than just respiratory acidosis. Examining the anion gap (which is elevated) demonstrates that the patient had a metabolic acidosis as well. The hamster would have been helped with the vent, in order to bring down his PaCO2.

    Ah well...such fickle things, our patients. I've lost a few hamsters myself despite my best efforts. Even recovered a Russian dwarf in the walls of the house through the use of bribery via pizza crust. However, sometimes out patients die despite our best efforts. Know that you're not alone.

    The good thing about hamsters is that they are relatively inexpensive to replace...unlike humans.
     
  5. Poety

    5+ Year Member

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    to all 3 threads above :laugh: :laugh: :laugh: :laugh: :laugh: :laugh: :laugh: :laugh: :laugh:
     
  6. Hurricane

    Hurricane Senior Member
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    My condolensces on the hamster. :(

    I have had to call a vetinary consultation myself recently. Not a code, but the patient did require urgent care. Came home after a long call night on my AI, and my (non-medical) husband and his friends were standing around our little kitty. The chief complaint: "Um, something's wrong with the cat." The patient exhibited marked nystagmus, drooling, decreased responsiveness, and a complete right hemiplegia. The patient was transferred to a tertiary care center. After a cost benefit analysis, we decided against the $800 head CT, as the patient's history was suggestive of environmental exposure to rat poison*, which was confirmed by a prolonged PT. Patient was started on vitamin K, and I am happy to say she has made a complete and total recovery. (I did some kitty PT/OT with her, involving feather toy and a laser pointer.) There was some concern about impaired meowing, as this was a left sided stroke, but if anything she meows a bit more now. Go figure.

    And last year my other cat (pictured in my avatar) went into status asthmaticus and had to be admitted for two days of continious nebs. And now I have to chase his ornery ass down every spring and give him prednisone and theophylline TID.

    I have high maintenance pets.

    * RE the rat poison: There is an OCD lady across the street who is a hoarder, and the health dept came and set a bunch of traps, and caught over sixty rats the week before the incident. Eek.
     
  7. Poety

    5+ Year Member

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    Oh my how very traumatic Hurricane! But I'm glad it all worked out in the end. My big episode unlike OPD's was with my dog Q who began to get very ill from Lyme's disease - he was ultimately placed on continuous IV fluids, NPO, tapered steroid dose (repeatedly) but he succombed to his illness 2 years ago. It was very sad - and people thought I was a bit off my rocker walking my dog with an IV in one hand, leash in other :(
     
  8. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    G_D! I do so NOT miss being a medicine intern right now!

    I forgot to mention (and if you had read my note in the chart, Dr. Anasazi, you would have seen it documented!) that in spite of the patient's flight to health on Monday night, the stated wish of the patient was to have its code status noted as DNR/DNI. ;)

    (and btw--how did that Russian dwarf end up inside your walls?
    Was this pre- or post-Cold War? )
     
  9. Anasazi23

    Anasazi23 Your Digital Ruler
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    It's still there now...taunting me, mocking me.

    As for the DNR/DNI; I heard that the case is going before the M&M board. I heard something in the elevator yesterday about you going to be called in to discuss this with the board.

    Apparently the DNR form was from the hamster's previous admission at another institution, which as you know, is void on this admission. Good luck at the M&M hearing. ;)
     
  10. PublicHealth

    PublicHealth Membership Revoked
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    Isn't the median lifespan of a hamster two years? I had a bunch growing up. Only thing I remember is that they LOVE to hoard grapes, pee with their asses up in the air, and bury themselves in cedar chips to sleep. Funny little critters.
     
  11. Anasazi23

    Anasazi23 Your Digital Ruler
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    Yeah, the Russian dwarf was obsessed with sunflower seeds. He would ignore all the rest of the food, and stuff his cheeks with sunflower seeds until his cheeks almost burst. Then, he'd retreat to his plastic house on the third floor and dump them off...hoarding them. He had a collection of sunflower seeds so large in his plastic house that he could barely fit inside.

    OldPsychDoc...did you get Lil'MissOldPsychDoc another critter? Or is she still mourning the loss of this one?
     
  12. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    LMPD is still in mourning--initial statements indicated that she "never wants another hamster". She has been dealing with it by spending more time on Neopets taking care of her virtual critters.
     

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