Emergency: Mother Wanted. Sarah Morgan

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СКАЧАТЬ to the resuscitation room.

      Seconds later Zach slammed open the swing doors of Resus and joined them at the trolley.

      ‘OK, what have we got?’

      ‘Twenty-five-year-old male, overdose—we don’t know what he’s taken. He was brought in unconscious.’ Nicky Roberts, one of the A and E sisters, briefed him quickly as they all swung into action. ‘One of his friends found him. Said he’d been depressed lately but didn’t know if he’d been taking any drugs. The ambulance crew put in an airway.’

      ‘OK.’ Stethoscope looped round his neck, Zach started to examine the man, his movements swift and methodical. ‘No gag reflex. Someone bleep the anaesthetist and let’s give him some oxygen.’

      Keely tried not to be impressed by the speed and confidence with which he worked as he took charge of the situation.

      ‘He’s got dilated pupils, a divergent squint and increased muscle tone and reflexes.’ His eyes flickered past Keely and rested on Adam. ‘Does that give you any clues as to what he might have taken?’

      Keely ground her teeth. He was doing it again. Ignoring her and asking Adam the questions. Why hadn’t he asked her? Why wasn’t he treating her the same way he was treating the others?

      Did he think she didn’t know the answer?

      She gave Adam a moment to speak but when he hesitated, clearly unsure, she stepped forward, her small chin lifting slightly as she spoke.

      ‘Could it be tricyclics?’

      Zach’s gaze swivelled to her and she saw the flicker of surprise in his blue eyes. ‘It could be.’ He looked at her for a long moment, obviously unsure whether to question her further.

      Keely took the matter in her own hands. ‘Obviously you’ll want certain tests done,’ she said crisply. ‘In my opinion he needs a drug screen and a blood glucose, BMG, ABG and U and Es.’ She listed the necessary investigations and then held her breath, waiting for his response. Would he give her a row for interrupting when he’d asked Adam the question?

      There was a long silence and then a ghost of a smile played around his firm mouth.

      ‘Then you’d better get a line in and send off those tests.’ He shifted his sharp gaze to one of the student nurses. ‘Pulse and BP?’

      Keely felt a rush of relief and reached for an IV cannula.

      ‘Pulse is 110 and his blood pressure is 70 over 50,’ the student nurse said quickly, flushing slightly as that hard gaze shifted in her direction. ‘Wh-what are tricyclics, Mr Jordan?’

      Zach jerked his head towards Keely. ‘Dr Thompson will tell you.’

      Was he testing her? Keely taped the cannula in place. ‘It’s a type of antidepressant. Unfortunately it’s quite serious in overdose.’

      ‘He’s tachycardic and hypotensive,’ Zach muttered, his eyes moving back to Nicky. ‘And his skin is dry and hot. Check his temperature, please. I’m sure Keely’s right and it’s tricyclics. What do you think?’

      Nicky shrugged and picked up a thermometer. ‘You’re the doctor, Zach.’

      ‘That’s never stopped you giving an opinion before.’ Zach’s tone was dry as he returned his attention to the patient. ‘OK, is that line in? Well done, Keely. Let’s give him a plasma expander—500 mils gelatin. Do we have a name for him yet? Address?’

      ‘The friend was giving his details to Reception. We’ll check,’ Nicky said quickly, despatching another nurse to talk to the receptionist.

      Zach drew breath and wiped his forehead on his sleeve. ‘Someone contact the GP, please—find out what he’s taking, if anything.’ He glanced up as the anaesthetist strode into the room. ‘Hi, Doug.’

      His colleague gave a brief smile of acknowledgement. ‘What’s the story?’

      ‘Overdose,’ Zach said briefly. ‘Don’t know what yet. We’re working on it, but we’re guessing tricyclics.’

      The anaesthetist rolled his eyes and snapped open the laryngoscope. ‘Bloody antidepressants.’

      ‘Quite.’ Zach’s gaze returned to his patient. ‘He’s got no gag reflex. I want to wash him out. We need to intubate him with a cuffed tube.’

      ‘By “we” I assume you mean me,’ the anaesthetist said dryly, and Zach grinned.

      ‘I do indeed. I’m not rummaging around in someone’s vocal cords unless I have to.’

      The anaesthetist frowned and reached for an endotracheal tube. ‘Isn’t it a bit late for gastric lavage? When did he take them?’

      ‘His friends saw him two hours ago and he was fine,’ Zach said calmly. ‘I want to try it and I want to give him some charcoal.’

      ‘You’re the boss.’ The anaesthetist shrugged and intubated the patient quickly, using a cuffed endotracheal tube designed to prevent liquid accidentally entering the lungs.

      ‘Great.’ Zach lifted his eyes to Nicky. ‘Let’s wash him out. Keep 20 mils of the aspirate for a drug screen. Then I want 50 grams of activated charcoal down the tube. And let’s do an ECG.’

      His steady stream of instructions left Keely’s head reeling and she watched in awe as he and Nicky worked together, their smooth teamwork a result of years of experience. Nicky seemed to anticipate Zach’s every move without being asked and he was so calm and relaxed that Keely’s admiration quickly turned to gloom. Would she ever be as confident as that?

      ‘He’s in urinary retention,’ Nicky said quietly, and Zach nodded.

      ‘That’s common after a tricyclic overdose. Try suprapubic pressure. If that doesn’t work then let’s put in a catheter. How’s that ECG?’

      He leaned over her shoulder, frowning as he saw the trace. ‘Well, that pretty much confirms Keely’s diagnosis.’

      As if to prove the point the student nurse came back in at that point. ‘I’ve spoken to the GP. He was taking tricyclics. Amitriptyline.’

      ‘Well done, Keely.’

      Zach’s quiet words of praise brought a faint colour to her cheeks and she suddenly felt deliciously warm inside. Maybe she would be as confident as him one day. He was the consultant after all.

      Zach lifted the ECG trace and stared down at it. ‘All right, Keely, you’re the one who wants to be a cardiologist. Take a look at that and tell me what you see?’

      He handed her the ECG trace and waited while she looked at it.

      ‘Prolonged PR interval and QRS widening.’

      ‘Right.’ Zach took the trace back. ‘Consistent with a tricyclic overdose. Let’s give him 8.4 per cent sodium bicarbonate.’

      Nicky turned away to do as he’d instructed and Zach turned back to Adam. ‘He needs to be admitted to CCU for cardiac monitoring. СКАЧАТЬ