My first BIG miss

One of my sicker kids came up to me in the middle of the day yesterday while I was sitting at the nurses station writing a note. He looked pretty relaxed and like he was doing ok, so I talked to him for a bit while I was writing. Then out of the blue he said "My tounge feels funny. Kind of tingly. It just started a little while ago."

OK I thought, probably not a big deal. So I ask him all of the questions that I can think of relating to electrolyte abnormalities, and it doesn't really sound like a big deal to me. So I tell him so and put it in the back of my mind. Well about an hour later, he's told my resident, the nurses and anyone that would listen that he's feeling tingly all over his body and his hands are getting crampy, and it feels like when his K gets lower. Ok not really a big deal, but this is not good!!! Resident orders a BMP and CXR, and we go to sign out for the night.

In the middle of signout the lab calls back with a STAT BMP showing a K+ in the 7's. STAT EKG is showing PVC's. Insulin + Glucose, CaGluconate and Kaoxalte go in and he's transferred to the PICU...OH SHIT THIS IS NOT GOOD. Long story short, he ended up being completely fine once his K+ was brought down to normal levels and he'll be back on the floors tomorrow.

However, the scary thing is that this kid came up to me and directly presented me with a problem. I brushed it off as something not serious...it didn't sound like Ca+ or high K+ to me...but there he is. I could have nipped the issue in the bud and looked like a superstar, but instead I was a space cadet and blew off someone who was SEVERELY sick. We're not talking "ooops, I missed something"...we're talking OOOPS I could have killed a kid by not saying anything. He could have flipped over into VTach or VFib and collapsed infront of me and I wouldn't have known what happened.

I know that I'm a third year student and that seeing the manefestations of disease are what this year is all about. I know there's a saftey net of 10 physicians, nurses, techs and janitors behind me to pick up what I miss. I know this one turned out to be OK...but what about when it isn't OK?


Resident Anesthesiologist Guy (RAG) said...

At least you'll have a patient to remember whenever someone talks about manifestations of hyperkalemia! This is what residency is about, man, BTW. You screw up, then learn from it. Don't get too upset about it - your resident didn't seem to concerned either. At least he did well.

Albinoblackbear said...

Don't beat yourself up (that is what the attendings and residents are for).

If you jumped every time a possible red flag presented itself you'd be the 3rd year who cried wolf and everyone would want to strangle you.

It's not going to be your first or last. I agree with RAG (for once) learning from the near misses (and misses) is what it is all about. At least you have the sensitivity to be shaken by it. Keep rockin'.

Dragonfly said...

But you will remember that one forever and be extremely on the ball about electrolytes from now on... And no harm done.
Seriously don't beat yourself up. When you are a doctor, you have responsibility and the buck stops there, but even then there are hierarchies of responsibility.
As abb said...good that you have the sensitivity to be shaken by it though...

OneDood said...

Not that big a deal, you are not suppose to know everything and your crystal ball doesn't always work. Whether anyone will admit to it, most would have ignored those symptoms initially. Move on to the next patient. Something else will happen next, it is called medicine.