Then I'd return to my office (yes, I had an office) and skype away...till either a pseudo-complaint came through or my eyes could no longer struggle with gravity.
The nurse informed me of a new admission so I followed her to the patient's room hoping to make it rather snappy and return to my favorite past-time. I met there a young man on the bed with two adults around him - a man and a woman. Quickly scanned him; stepped out and the nurse followed soon after. One look at her and I wanted to demolish her very existence. How the heck could she admit a patient like this? Unconscious! This was a clinic, not a hospital. Where was the equipment to monitor him? He needed a head CT Scan, an EKG, even X-rays; we didn't have any of that!
After pacing for about a minute, which felt like 20, I went back in there to break the news. "Sorry. We can't keep him because our facility isn't equipped to handle critical cases". Then I caught his wife's eyes...I mean, she was looking at me like I was her only hope. How can you put your hopes in someone like me??? I just wanted to surf the internet; I had no idea what was wrong with him and what to do with him. But till today, I can't explain what happened to me. I suddenly awakened and took control! I told the nurse to start an IV line and while taking his vitals, I took the history. We took his blood sugar, which was very low. We immediately administered hypertonic (high sugar) fluids, and in seconds literally, he came to life. In minutes, he was as good as new, like nothing had ever happened.
The story goes thus: his boys came home before dinner and dragged him out to the bar. He drank on an empty stomach and suffered from alcohol-induced hypoglycemia. Patients have described symptoms such as hypothermia, nervousness, rapid heartbeat and sweating (American Diabetes Society), but coma occurs when the blood sugar level falls very very low, which can happen quickly if fasting or exercise precedes drinking. Why does this happen? Because alcohol blocks the liver from making glucose (gluconeogenesis) so that you run out of energy in no time.
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| Mayo clinic website |
The treatment is giving the individual glucose: 1 teaspoon of sugar or fun sips of coke or (even better) indulging on hard candy- ok, maybe a couple! However, if the person is comatose like in our case, an intravenous infusion with hypertonic fluids (20-30cc of Dextrose 30%) should wake him up. We had a less than ideal concentration, but still flushed it down until he woke up. As long as he got the glucose...
I did retire to my office after my patient was fully up and chatty. But I couldn't skype that night. I began reflecting. What if I hadn't checked his blood sugar? This was Cameroon; I was the patient's 911. What if I wasn't prepared for this? And then I realized that I was my greatest obstacle. And that I had to get out of my comfort zone!!!
References:
American Diabetic Society
uptodate.com
get.smarter.com
cs.stedwards.edu
