By 430AM with seven new admissions, and one with requiring blood product transfusion and had a heart rate of 67~134bpm, and multiple unsteady PR bleeding patient climbing off their beds, we felt busy enough. Then everything just got worse when a patient that had started coughing up fresh blood with an old tracheostoma site oozing pinkish fluid about 3 hours ago which was remedied with oxygen therapy and suctioning, further deteriorated with copious amounts of fresh blood sputum, and unstoppable fresh bleeding from the stitched old tracheostoma site despite pressure applied, and a neck dissection wound that was looking awfully swollen and bulging. Thankfully the doctor was willing to come from offsite to assess and our call system for allowing a slight relief from admissions. Thankfully the patients IV assess was quite patent and on-call doctor was willing to come and help with blood taking. Oddly enough hemoglobin levels only fell from 9.9 to 8.7 despite a suctioning tank with 1L of dark red (we did not have time to flush between suctions because it was almost continuous).
Bedside tracheostomy was difficult with multiple attempts resulting in false track, and the patient had oxygen desaturation of almost 68% despite full rate oxygen therapy via rebreathing mask. Thankfully by 530am, tracheostomy was successfully inserted and ICU was willing to take over the case. As I explained the case to ICU doctor, she quietly asked “how can you all be so calm”. You have no idea.
Now I can get back to the plasma transfusion, and all the IV fluids and medication, and that patient who won’t settle down despite a high blood pressure and a bloody nose. Thank god for 7AM.
To remedy that night shift, had a great time with my CU buddies at dinner. Despite waiting for an hour and a half for chicken hotpot and 8 people squeezed in a 6-person table, dinner was filled with constant chatter and endless laughter. Even though this dinner took months to gather, it was just awesome! So happy I made it despite that nerve-wracking night shift and my poor tired muscles!