Fly Away With Me

My final night float elicited all kinds of excitement:
-A 77-yr-old woman who had collapsed and was found to have a blood glucose level of 12!  After several amps of D50, her blood sugar increased temporarily to 70, then precipitously dropped again.  I started her on an intravenous infusion of D10, then ordered some extra D50 for back-up.  Turns out the hospital was running low on D50 and had to reserve a few amps for the crash carts.  Meanwhile, the patient's blood sugar dropped to 41 despite the D10.  Theory: I'm guessing she took some "extra" doses of her extended release glipizide--an insulin secretagogue that can take quite a while to metabolize completely in elderly patients.   I ordered glucagon to be administered every time her blood sugar level dropped to the 50s.  After 6 or 7 doses, we finally got a blood glucose reading of 124 which fell a bit to 90 an hour later, but managed to stay consistently above 75.  By which time, the patient was alert enough to drink juice when prompted.
-A 13-yr-old boy with an impressively large R knee laceration after taking a tumble off his skateboard.  The gaping wound revealed some subcutaneous tissue which astounded his parents.  You know you're among hunters when the most frequent remark about large lacerations is: "You can see the meat sticking out!"  As I was carefully suturing the laceration (13 stitches total),  the boy pulled a tiny replica of a skateboard out of his pocket to reenact the scene of the accident for me.
-A cab driver with posterior epistaxis that had been bleeding nonstop for 2 hours, complicated by hypertensive urgency with systolic blood pressures in the 180s.  He got a double lumen balloon catheter inserted into his right nasal cavity for tamponade, and several doses of IV labetalol for his blood pressure.  Ultimately, he would need to fly to Anchorage for definitive treatment by an ENT specialist.

The funny thing about coming off of night float and taking the morning flight back to Seattle is that almost inevitably you end up on the same Bethel-Anchorage flight as some of your patients!  On my flight, I spotted the woman who had the breech delivery in the village (on her way to the NICU in Anchorage to see her newborn), and a little girl who had been treated for R cheek cellulitis secondary to an odontogenic abscess (scheduled for oral surgery in Anchorage later that day).  If only the cab driver with the nosebleed had driven us all to the airport and hopped on the flight with us, it would have been a perfect trifecta.