An elderly man from nursing home was admitted under my team 2 1/2 weeks ago for delirium secondary to UTI, with a background Hx of Parkinson's Disease, ?demetia, IHD and Type 2-DM. He also has a permanent IDC, presumably for chronic urinary retention. As expected, his cognitive state fluctuated on a daily basis for two weeks. At best, he was orientated to person, time and (somewhat) to place - at his worst, he was aggressive, as typified by throwing his breakfast cereal at nurses, accusing medical staff for "imprisoning" him against his will, and on numerous occasions tugged at his IDC - with the latter being a constant source of grief for all involved in his care.
Many a time we found him fiddling at the catheter, and the bag draining blood-stained urine. And many a time, we managed to get it back under control. None however was as bad as the latest episode this morning, when he pulled his cathether (again), got his IDC blocked presumably from a blood clot, went into acute urinary retention, and was rushed down to ED for a suprapubic catheterization. At 2am. All initially went well after 1.5L urine was drained from the bladder, and the urine bag was subsequently draining clear fluid.
The crunch came when my medical team did the usual morning WR. We found him in his chair, incoherent, sheet-white, with bag draining frank blood. Systolic BP was around 75, and urgent FBE returned with Hb dramatically dropped from a relatively low 80-87 to 45.
The last I saw him? He was being transfused 4 units of packed RBCs. I do not know the outcome of his situation, given I got called away for tutorials (at two different hospitals), and never had the opportunity to return.
First off, I hope he came through OK. Secondly, I wonder if there is anything else we could have done to prevent that in the first place. The IDC, I feel, was the main problem. With him having a permanent IDC, he is always at risk of UTIs (which then predisposes him to delirium, the constant pulling *sigh*, and the inevitable meatal trauma/bleed). However, if one decides to take the cathether out, he then goes into acute urinary retention, which causes discomfort/pain (and that also happens to exacerbate/trigger delirium)......
*sigh* *sigh* *SIGH*
Any thoughts on this, anyone? =\
Labels: Medicine/Hospitals/Medics
