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It's starting to fire in the E.R. In the waiting room, patients are farandole the wounds, already 7 waiting. I'm hot, the wrist is soft, the needle holder in the right hand, the hook clip in the left and the suture thread between the teeth. They're not going to be disappointed.
And then No…… here are the firefighters!
Quietly, they enter the care zone:
-What's the problem?
-A gastroenteritis!
-………… how old?
-23 years, she had a malaise after a nurse friend gave him an injection to stop vomiting.
I quickly look at my care room, all the boxes are taken, I have only the room of shock (for serious patients).
-Well, we put her in the hallway waiting.
I go back to my sutures and hear a distracted ear:
-You can have a little help to put it on the stretcher (firefighters)
-She can not get up? (nurse)
-Bin She is not in shape, she does not even have a radial pulse. (firefighters)
My distracted ear takes fire, small tachycardia, I drop my instruments and go back to the firefighters (and the patient at the same time).
Indeed, no radial pulse (wrist pulse): Sign of gravity, serious hypotension, shock, in short it is not normal especially for a gastroenteritis. It will not stay longer in the hallway, I pass it in the room of shock, we perfuse urgently…. I need a blood pressure, but hey, she's talking, so it shouldn't be that bad. I mean, no radial pulse!
The apparatus for measuring tension fight, it does not lower the arms, but it has trouble, after two long minutes, it drops its digits: 43/29. It may sound a lot, but you have to know that the normal voltage revolves around 120/70, but for our patients we often remove the last number talking about 12/7. So 43/29 it does in the current language……… 4/3.
-GULP!!!! We fill it!!!
I look at her, she talks to her, she answers, I raise a tension, almost the same numbers. We start the initial support, I call the resuscitator, we look together for the origin of the problem. Has anyone come with her? A witness who was present? Nothing. We run the widest possible balance sheet. With the initial treatment, it improves a little since we arrive at 67/35 of tension, it is Byzantium!
For more than an hour, we continue the resuscitation maneuvers while trying to understand what is happening. Finally, I have her mother on the phone explaining to us that she has a particular disease (a rare hormonal disorder) that fully explains the signs.
The specific treatment is put in place immediately and it is starting to improve. She will end up in resuscitation for the night to make sure everything is going for the best she will be out by 48 hours.
By looking for a little closer to the entourage, she has more or less voluntarily stopped her daily treatment, we will have to review it with her at a distance.
In the end, I went back to my sutures, quietly. 43/29 blood pressure! Too bad, I did not take my pulse when the numbers were displayed… to laugh… to ex!