Attention: in the Focus of Consciousness

Abstract

A resident physician was finishing his last night shift at the end of a week of night calls. It was 5 a.m. and the last few hours had been particularly straining because of several unstable patients. The resident was feeling very tired, but he decided to do rounds one more time on his patients before getting some rest. While evaluating a patient whose hemodynamic status had recently worsened, he was emergently called for another patient who had been inadvertently extubated during positioning. When the resident arrived at the bedside, the patient’s oxygen saturation was 85%, and he was being mask ventilated by a nurse. The physician took over the ventilation and asked the nurse to prepare for reintubation. Because the patient was agitated and resisted mask ventilation, the resident decided to give him a bolus of fentanyl and midazolam from the infusion pump. Immediately after the injection, the patient became severely tachycardic and hypertensive.