Last time I spent almost on autopilot. The events of the last days brought me to the state of autism and the only desire was to find any horizontal surface and stretch out my legs. The duty began as usual: a sample of food in the kitchen, a detour, a clinic reception (only two people).
About seven in the evening they brought three of them to the ambulance: one "To sanitize the oral cavity", two more to the tuberculosis department "on return", to x-ray control, that is. All three were hospitalized. At 20-00 the change of nurses is the time to eat. I was already beginning to eat, as a frightened nurse came from the hospital # 6 (psychiatric).
- KV, our patient is getting cold !!!
"Did you die?" - No, it's still alive. He has a temperature of 35.2 Celsius.
-And what does she complain about? - He already does not complain about anything. He's quiet here.
After a prolonged thaw outside the window, the blizzard was in February. The trail skidded, and a snowy blizzard whistled shrilly in the sagging wires. Getting out of a warm hospital and going through the entire zone to psychiatry was not terribly anxious. The food will cool down.
"Well, give him a second blanket." - Yes, he has two.
"Then give me a third." Reluctantly, he agreed reluctantly and ran away.
I threw the already cooled ravioli into myself, and I began to take coffee. But where there ?! The same employee: - K.V. his temperature is already 32.5! Come, see for yourself.
There is nothing to be done - he got dressed, and, covering his face from the wind and blizzard with a collar of his coat, he went to "save" the person who was cooling down, taking on the road that had just replaced him and therefore was very unhappy with the nurse.
The patient lay in the ward for "quiet." His name was Misha Sh. He really did not complain about anything: he just looked directly at the ceiling and quietly, quietly, he could barely hear the syllables of mi-sha-kr-sha, mi-sha-kr-sha. The color of his face, even in the semi-darkness, seemed deadly pale. I slid my hand into my shirt shawl - so faster and more accurately - the temperature of Misha was little different from the temperature of the standing bedside table by the touch. I tried to feel the pulse on my wrist - in vain. Auscultatory counted 44 heart beats per minute. The pulse was barely probed only on the carotid artery. He forced the orderly to bring a thermometer - the mercury column did not even move to the densel, frozen at the level of 34. And in the hospital it was quite warm, I would say even hot - in a dressing gown over my military shirt I was pretty sweating. It was not possible to get acquainted with the history of the disease - the history of psychiatric patients is closed for the night in the safe and there is no access to them, apparently they are kept secret by the state. From the list of appointments, I clarified that for three days already Misha had been pricked with prednisolone and rispolept. The picture cleared up a little. The first thing I decided to do was warm the patient. Between the legs, where the femoral arteries, Misha placed bottles of hot water. From the internship I remember that it is necessary to warm the patient gradually, so as not to cause arrhythmias and fibrillation (cardiac arrest). Then, through the vein, we let atropine - zero effect. Prednisolone 120. Once again, atropine. Fifteen minutes later, it was possible to determine the pulse on the ulnar artery. Heart rate - 60 per minute. They began to pour a warm infukol. After an hour, the pressure rose to 90/50. The body temperature was not raised. I had to drip dopamine. Charging the system and adjusting the speed, so that neither more nor less, but as much as necessary (10 μg / kg / min.), Left with Mischa, the sister and the controller, and retired to the polyclinic. At two o'clock in the morning I was again called to the sixth hospital - dopamine was over. Misha was lying in the same position and still mumbling: mi-sha-kr-sha. The body temperature did not rise an inch. Everything repeated in a circle: the bottles-atropine-prednisolone-dopamine. And so on until morning. In the morning, I was changed by a psychiatrist, Misha's doctor. - You did not perborschili you accidentally with rispoleptom?
- And what are you, Misha was treated?
- How did you know?
- Yes, he always is: quiet and cold.
I doubted it, I did not argue. Already at home I read about spontaneous hypothermia and Shapiro syndrome. Rispolept with it sometimes is even useful. Here you are, my friend, and Santa Claus.