Seizures Pills for Sparky

you know the cat lady cliche? well, i took care of the cat lady dood.

so, i get report that i'm getting this hypotensive respiratory distress dood, some guy who's already had 4 liters in the ER. on his way out the door to go see somebody else, the dr tells me, 'if his pressures are still low, let me know so we can throw in a line.'

first pressure-50/30.

great, bring on the pain.

thankfully we have kick butt pulmonologists that are super aggressive, and wanted to throw in a line to get some pressors on board. except of course that he was a hard stick (read: fat guy). first we try for a subclavian, only, with pressures so low, we can't hardly feel a pulse, which is how you landmark where you aim for the line.

warning; teaching moment ahead...

central lines are lines that go anywhere into a major vein and then thread right to the heart, which means that any med you put into the line goes right to the heart, so meds work faster. also, some meds that you give are vesicants (bad for tissues), and if you give them in a peripheral line, like one in the arm or hand, and the line breaks, you can end up destroying the tissue (extravasation). plus, the meds you give for maintaining pressures have a short half-life so.........central lines are better. also, when you draw labs, you just stop all the meds, draw your labs, and you save your patient another stick.

course, normal size people don't get sick, sickly fatty fat people get sick, mostly cuz they're fat, and they're hard to work with. sometimes you have to have five people in the room to put a foley in. fact, there was this one time, we had this nurse named Skinny Mexican who got the short straw and had to put in a catheter in a 5 person fat lady.

so, this is the scene. one nurse is holding a leg, another nurse has the other leg, and two nurses are using a drawsheet to hold back the fat, and Skinny is going in for the stick up the middle. and that my friends, is a 5 person fat lady. there was also a doctor NOT holding anything in the room for good measure.

well, the doc starts laughing (the lady, by the way, completely a/o) and so does one of the nurses holding the sheet. well......the sheet slips, and then the other nurse holding the sheet starts to laugh and lets go of the sheet. so now the whole room is laughing, with the exception of the patient......and Skinny, who is stuck up to the elbows in this lady's.....area, yelling 'HELP, i can't get OUT!!'

ah, fat people. gotta love'em. the way they smell cuz that can't wash all of their....surface area. anyway, that's a topic for another post.

back to cat lady dood. so, we're trying to put this line in, and the guy starts crying cuz he has a cat at home that has seizures and needs his meds. at two o'clock. who's gonna give Sparky his meds?

so his kid (who turns out, is a normal dood) comes in and asks questions about his dad, and yadda yadda yadda. kid goes home, promises he's just across the street, and call if we have any questions. and to feed the damn cat his pills. well, kid calls back and wants to ask his dad where the pills are.

in a cup on the kitchen counter.

i don't see a cup anywhere. well, i'll keep looking.

five minutes later, another phone call.....

are the meds with dad?

uh, i'll go look.

so, i'm looking through this grocery bag of meds, clonazepam, lortabs, allegra, seroquel-basically, dood has tons of meds, and then paydirt. a bottle of something made out for Sparky Hypotensive. I hand the bottle to Mr Hypotensive, and he puts the bottle 1 centimeter away from his face to read the label and says, 'yeah, these are Sparky's meds."

great, Mr Hypotensive can't see two inches in front of his nose and he's got 30 bottles of pills. polypharmacy waiting to happen. probably how he dehydrated himself and tanked his pressures in the first place.

damn cats. and their owners.