Adrenaline

Been working myself silly over the past few days, exacwerbated by the new registrar who although nice, is still adjusting and thereby requiring me to do some of her work.

This weekend was yet again another 25 hour work fest (12.5 hours per day) topped off by the development of what I think is a viral LRTI beginning to consolidate my lung parenchyma. So I've been trudging from paediatric ward, to nursery, to maternity ward, to operating theatres to ED... sniffling, complaining and just generally exhuasted.

It was a sunny winter's afternoon today and I was looking out the window wishing I was like a normal person who had weekends and wasn't stuck in an Emergency Department. Then the triage nurse came bolting out of her cave, "Where's the Paeds*? We've got a category 1 coming in!" At that point my heart sank. Category 1 means they are dying and need to be seen as soon as they hit the hospital. And so we gathered a posse of doctors and nurses and ran off to the Resus Bay to await our arrival. We got some garbled info over the radio system from the ambo's. A 10 month old baby with swollen lips and shortness of breath after being fed peanuts for the first time.

Crap... anaphylaxis.

Apparently the baby was slippping in and out of consciousness, hardly breathing and worsening by the minute. My heart sank even further.

Soon the ambos burst thru the door carrying a limp figure. His lips would put Angelina Jolie to shame. He let out a whimpering wheezing sound... not even a cry.

The ED reg (the only more senior doctor there) attempted in vain to get a vein. She looked at me and told me that I would be able to get one since I was the paediatric RMO (oh boy...) I prayed hard that this cannulae would work and thankfully I got it first go (a rarity for a 10 monther)... I've never been more excited to see blood spurting into the flashback section.

Training took over and next thing I know I'm ordering salbutamol nebs, IV adrenaline, IV hydrocrotisone, IVFs and po loratidine. Then we wait.

The pulse oximetry shows an improvement in the oxygenation... the ECG dots show a tachycardic surge as the adrenaline hits the myocardium... the wheeze turns into a whimper and then evolves into a scream as the baby's body reacts to the adrenaline and then the sound every paediatric person loves to hear....

Crying!

After a while the baby started to pick up and was able to breath on its own without additonal oxygen. The steroids kicked in 4 hours later (thanks to the delayed effects of RNA expression) and as I walked out the door to go home I saw his beautiful white eyes for the first time. I realised that during the entire resuscitation he hadn't opened his eyes once. But now his bright white scleras beamed back at me and I realised that I'd made a difference.

I had been in charge of the resus and although there were definite places I could have done things better... now that baby is alive (and not dead) thanks to me (in some part). Although the baby had been pumped full of adrenaline, I felt that I probably had just as much surging thru my veins.

It was so exhilirating to bring this limp baby back from the brink and yet so scary. This is the pinnnacle of medical coolness. The reason why I like medicine. Like honestly, how many desk jobs let you do cool stuff like that?

* I have no name... I am just called "The Paed" as if I am the past tense of micturition. I'm sure it's a nurses way of subverting some subliminal form of control over us.