Case 48: This Is a Serious Problem

Abstract

You are a new attending anesthesiologist at a university hospital. It is late in the evening and you are on second call. A craniotomy has been ongoing for 4 h and there is 1 h to go. Your resident (32-year-old married male), although competent, does not seem particularly interested in what you are trying to teach with him. You have worked with him before but at that time he had seemed much more interested and willing to learn. Today he also complains about being cold, although you feel warm. He is wearing a long-sleeved gown. He has been to the rest room at least three times in this period. He now wants to go again. You ask him if there is anything wrong, but he states that he is fine but needs to go to the bathroom. He is in the rest room when your colleague, who is first call, comes into the OR to send you home. You tell him about the case and remark to the first call attending that the resident seems to have TB (tiny bladder). He tells you that this has been his impression also. No more comments are made and you leave the OR. As you get out into the corridor, a nurse calls you urgently to say that there is a person lying unconscious in the hallway outside the men’s rest room. You run to the scene. The collapsed person is your resident. He is cyanotic and not breathing. With a firm jaw trust he starts to breath, albeit slowly. You call for an oxygen cylinder and give 100% oxygen via a face mask. With the help of your nurse you attach an oxygen saturation monitor and BP cuff and establish that his vital signs are within normal limits but he still unconscious. You pinch his arm and he pulls the arm away. You are very concerned and call for more help. Aided by the nurse, you quickly establish an IV with Lactate Ringer. You give him an ampoule of 50% glucose as you think he may be hypoglycemic, but there is no improvement in his consciousness level. What will you do?