Numb

I enjoy reading other medical blogs out there and have learned a lot of useful tips and tricks along the way.  This morning, in the ICU, I had a patient with cancer who had just completed one of her rounds of chemo and was in a pretty bad way from the side effects. She was neutrapenic and with a very bad stomatitis, that caused her so much pain that she was unable to swallow food. And because she was neutrapenic, we couldn’t pass a nasogastric or dobhoff tube to feed her, nor could she have a surgical PEG tube placed. So her only option was to get TPN. TPN is basically feeding you through an IV, and it has lots of undesirable side effects, primarily it increases your risk for infections, and when you are neutrapenic (you don’t have the cells to fight infections) this is a serious risk. So on rounds this morning, we were lamenting this situation, when I remembered reading on one of the ER blogs about using nebulized lidocaine in the ED for making passing an NG tube more tolerable to patients. The idea being that the lidocaine is administered over 15 mintues, coats all of your mucosal surfaces, all the way down your throat and does a good job of numbing every thing up. There are no risk to the airway, no risk of inducing an infection like with a dobhoff tube. So we gave it a shot, and guess what, she was able to get some food down after a neb treatment. So that felt pretty good to be able to come up with a creative way to help a patient, something the attending had never heard of trying before..

And just because I haven’t posted any tunes in a long while…

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on February 4, 2012, in Hmmm thats interesting, Tricks of the Trade. Bookmark the permalink. Leave a comment.

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