My night

[fredericks]

I worked on this patient last, a woman with a tragic background/disease history - I mean, straight up sob story tragic. My tasks with her included changing the bandages on her feet; her overarching diagnosis was septic shock, and that precipitated her necrotic extremities. In the case of her feet she ended up getting one partially amputated and the other thoroughly debraded, to the point where it *looked* like the toes had been amputated. The course of action immediately post-surgery was a simple wet-to-dry dressing. Imagine you have a huge cut and you stick some cotton in it, and then are expected to remove the cotton in a couple of hours before reapplying some fresh cotton. That mental ouch? Multiply it by, oh, two stumps of feet. The patient had an analgesia pump to help, and she was certainly laying on it as I worked on her first foot.

And even though I knew she'd gotten the debradement/amputation deal and I saw that the gauze the earlier nurse had put on had blood seeping through, nothing prepared me for what I saw when I finally removed the bandages: bone. Pieces of mangled tissue with the distinct glint of bone...and in the case of the partially amputated foot, the obvious head of 1st metatarsal. Thinking back on it now I'm pretty sure I had little reaction during the entire drawn out procedure - one foot, then the other: remove the ACE bandage, wet down the cling wrapped around the tissue, remove the cling, apply fresh cling, wrap a new ACE, tape. All soundtracked by the soft *ding* of the patient pressing on the PCA pump button. She actually raised her foot to watch me work on the second one, the more reduced one. She must have been floating on morphine at that point, because I would have screamed bloody murder if I realized that's what my LE looked like.

I'm back in tonight (switched days with a co-worker, so I end up with three days off in a row again). Praises be that the night remains relatively peaceful.

Comments

[fredericks.livejournal.com]

No. I believe the story is she went in for some routine procedure - kidney stone removal? something along those lines - and it snowballed into septic shock, renal failure, and all sorts of non-fun stuff.

She just had the surgery yesterday. I'm thinking they're going to graft tissue over the areas to prep her for prostetics...? Wet-to-dry isn't terribly conducive to healing tissue anyway, as it tends to yank up new tissue growth along with the necrotic tissue it's supposed to remove. Hopefully there'll be a change in her course of treatment within the next few days.

[emily-goddess.livejournal.com]

Routine surgery can lead to that? Is septic shock treatable, or will the necrosis just spread and eat away at a person's body until s/he dies?

[fredericks.livejournal.com]

Routine surgery can lead to that?
All that paperwork they make you sign before any surgery? It's legal-ese for "sometimes shit happens, we're human, the body is a fragile thing". The definition for septic shock is constantly changing. I think the largest held def. is that it's an almost idiopathic immune response to something done to the body, and kidney failure is a big part of it. It's treatable, but the key is to stop the body from shutting down. Once that's done you basically deal with the aftermath. Necrotic tissue is dead, and there's no regeneration possible. At least, not on as large of a scale as to recover dead fingers and toes. The body does maintain circulation on the live tissue around the dead stuff, though. Once you stop the shock the necrosis doesn't tend to spread AFAIK.

[emily-goddess.livejournal.com]

Yeah, I knew stuff could happen in surgery, but I thought it was mostly nicked arteries, cutting too deep, the occasional sponge or clamp left behind - errors of the human surgeons who may or may not have slept in the last 36 hours. I didn't realize the body could have an adverse reaction to surgery, although put like that it doesn't surprise me.