Friday, September 7, 2007

Self injecting insulin?

There was a sick call at work the other day and I decided to work 11a-7p. I could tell from the minute I walked in that it was one of 'those days'. Security sitting in the hall 'guarding' someone, people moving with purpose, flags up on a lot of charts, charts in the 'right rack' where we put people who have been triaged back to the waiting room since all the ER rooms are full....the only things missing were the police and victims inc. Before too long they were in attendance too.

Since it wasn't my usual day to work I was put on the trauma assignment (my least favorite assignment...give me a nice clean MI (not inferior) any day) A friend of mine was on my usual assignment, cardiac. And she looked pretty busy with an admission and young diabetic who kept going hypoglycemic even with a D10 gtt and a few amps of dextrose. It wasn't really the time to hear the paramedics calling in with a guy who fell off his roof and was in respiratory arrest.

When the ambulance arrived it was obvious how severely injured this poor guy was. He was intubated and still, not the stillness of succs either. He was brought to a cardiac room briefly while CT was called, a dopamine drip was hung since he was hypotensive despite two large bore IV's w/o. During this I answered a call in the hypoglycemics room, she wanted something for pain....ummm, ok. I'll let your nurse know when she is done trying to save the guys life in exam #7.

CT revealed a C2 fracture with splaying. It just confirmed what we wasn't good. We are a small, community hospital, and before the patient had even arrived we had called lifeflight to take him to a larger hospital, they were still 10-20 minutes out. As we don't even have a helipad the medics had to package the patient up to bring him to the small airport up the street that almost looks like farmer John's cows must be in the lower pasture this week.

My friend went in to check on her hypoglycemic patient and found an insulin syringe uncapped in the patients bed. The patient said that it must have fallen out of her purse, but my friend suspected that she had self injected insulin and that was why her glucose kept dropping. She lost it on the patient and they searched her things and found some oxycontin and a few other drugs, but not insulin that I know of.

This girl is known to us as someone whose baby came in with bilateral burns to her hands and who will have a 'seizure' when she doesn't get meds she asks for in the ER. So, I don't doubt that she would self inject insulin. The question is has she now crossed the line from drug seeking dirt bag to someone who should be IEA'd and lose custody of her child? She had already been reported to DCYF for the previous visit.

I know that I'm glad I wasn't in my usual assignment that day!

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