My Last Night Shift

Third in our series "Diary Of An IMG"

My last set of nights for T&O rotation this week and I was excited as this would be my last nights this year as a foundation year 1 doctor. I followed my usual night shift routine and came into handover at 8pm which were simple jobs like chase bloods and patients to be aware off. After the handover I usually like to go to all the wards I am covering to see the worklist and also I think it is nice to say hello to the nursing staff. Around 10pm while I am doing ward jobs, I get escalated a patient who is NEWS score (early warning score) is a 10. She was hypotensive, tachycardia, desaturating and tachypnoeic. The ANP was already there and was managing the patient. I looked at the history of the patient and she was a day 1 post op admitted for a fall and head injury. We did a blood gas on her and she was acidotic and her potassium was 2.4. I called the medical registrar to ask for advice as the patient was acidotic 2 days in resus in ED. The medical registrar was kind enough to come down to review the patient herself and did a full A to E assessment. At this point her GCS was 14/15 and she was still obeying commands. The med reg was managing her for the time being and her treatment escalation plan was for only ward based care.

Fast forward 2 hours later, I get a bleep from the nurse in charge saying the patient had removed her nasal specs and desaturated to 60%. I rushed there and she was already on a non re-breather mask. She was centrally cyanosed and after 2 minutes, her saturation increased to 95 on 15L. I escalated it to my SHO who came to review the patient and a blood gas was taken. Her pH had reduced further and now she was retaining CO2 as well. The patient was really agitated and the GCS had dropped to a 10/15; she had deteriorated. I called the med registrar again and she came down to the ward then advised comfort care and that the morning team should review first thing in the morning. We called the next of kin and informed them that the patient had deteriorated over night and advised them to come down to see them at their earliest convenience.

As the morning approached, I had to review a few patients which were all manageable. I was waiting for the morning handover and I felt exhausted. I was grateful for my ANP as she was very helpful and I was just happy to be going home.

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