Monday, October 22, 2012

Whipple Chaos

A Whipple (or pancratacoduodenectomy) is a rather nasty surgery. They take out a piece (of a variable size) of the pancreas, and they take out your duodenum. Then they stick the NEXT part of your intestines (the jejeunum) to your stomach sort of like they would in a gastric bypass. They also attach your bile duct in there somewhere. Needless to say, when you go around stapling different body parts together that wildly, there tend to be...problems. Recently I took care of a whipple (ok, several whipples) with a Problem. You see, post-op they gave her a barium swallow, to make sure all those staples were holding. They were! (yay!) but that was on Monday. And now it was Friday, and...wait...NO bowel movements since then? Like...NONE? Ok...are they NPO? No? Cue sounds of impending doom. I spent the next TWO DAYS (on a five patient assignment) trying to fix this. Using Any Means Necessary. By day 2 we had dropped an NG tube, and there just wasn't...any...peristalsis. Wanna know how I knew this? The daily X-rays were showing the barium. From monday. In the SAME PLACE. So i'm spending the whole time saying to the team "guys, the enemas, the laxatives, the suppositories? THEY ARENT WORKING. Youre going to have to help me out here". And the attending is like "nono, just MAKE IT HAPPEN". and i'm like "...HOW?!?" So They want a CT scan, because by day 3, his mental status is going wonky, and he's getting tachy, and his white count is going from 11 to 20 over MY SHIFT. But here's the thing. Barium Swallow barium is 100% dense. CT contrast is 2% dense. The barium in his belly is basically acting as a shield that renders his whole belly opaque. And WHY can't I just "get it out of there"? BECAUSE I CANNOT TURN PERISTALSIS ON WITH A SWITCH!!! So instead, when his white count was getting ridiculous, his GCS had dropped from 15 to 13, and his vitals started to go off, we ran him over to the ICU. Maybe they'll have better luck explaining that i do not have a magic peristalsis wand. And they might want to fix that infection :-p


Candi said...

Ok so let me get this straight. For 3 days of peristalsis, the doctors just let your patient sit?? I don't understand. What were they waiting for? I'm not condemning, I'm just wondering. I mean wasn't there something they should have done?

Alpine, R.N. said...

well they were giving TONS of laxatives...and like, 2 enemas a day...some bowel regimens take a couple days to work. It's when the nurses are going "aint gonna work!! fix it!" and the docs are like "hmmmmmmmm" that i get pissed :-p