Monday, January 29, 2007

Electricians can disrupt your day, can't they?

I got off work at 7:45 this morning with the expectation of being able to sleep for a few hours before having to take care of the business of the day. Boy, was I wrong! My landlord had made arrangements with a local electrical contractor to upgrade the service in the house from 100 to 200 amperes in each of the three units in my house. They showed up at 8:30, and by 9:30 our power was shut off while they were in the basement doing the transfer. It took until nearly 4:00 before power was restored. Normally I wouldn't give it a great deal of press, but it really did a number on my ability to sleep. Considering I got about 3 hours overnight, I was really looking forward to it. However, once I'm all done venting here, I am going to bed.

We had an interesting night, and although it wasn't terribly busy, calls were spread out enough that we got sent at a little after 6:00 this morning for an allergic reaction to medication. The patient was an 86 year-old female with a history of Atrial Fibrillation for which she takes Coumadin who was also taking Lamisil to treat a fungal infection of one of her toenails. She told me that she finished the medication this past Friday but since mid-day Saturday she's been itching to the point where she hasn't been able to sleep, and she suspected that the Lamisil was the culprit. I don't, but I will get to that in a bit with a single comment that I will make. She denied having lung congestion or difficulty breathing, and she had no visible hives or rash. She was pink, warm, and dry, alert and appropriately oriented, and ambulatory. In fact, she was fully dressed with her purse in hand awaiting our arrival at her apartment.

Her vital signs were all within normal limits, her lungs were clear, and she denied chest pain, dizziness, shortness of breath, and nausea. Her abdomen was soft and non-tender, pupils equal and reactive to light, neck supple, she was able to move all extremities well and had equal grips, and she answered all of my questions appropriately and followed all of my directions.

Our treatment included 2 L/min Oxygen via nasal cannula, a saline lock in her left interns vein which was flushed and patent with 10 ml of normal saline, and 25 mg of Diphenhydramine IVP as well as 125 mg of Solu-Medrol IVP. I decided against giving her Epinephrine - although it would have been appropriate for her to have it, it wasn't necessary as she had no airway compromise or noted wheezing, and I also didn't want to possibly put her into an arrythmia that I would have also had to treat. Transport to the hospital was uneventful, the patient was stable with no major changes to her condition other than her itching stopped after the Benadryl. On our arrival we brought her to the assigned treatment room and moved her onto the ED stretcher in the room, I gave report to the nurse I transferred care to, filled the attending physician on what was going on, got all of the information I needed for demographics and billing, and we were done. Fairly routine call in many ways.

Did I mention her black and white tabby cat that was shedding all over her apartment?

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