The sh*t hit the fan at the ER/referral tonight. I am exhausted. This was my 7th day on in a row, and I am potato done. Thankfully, I have the next 3 days off before I have to work Memorial Day at my real job. We're going home to visit family.
My first transfer of the night was a doozy of a case. It was a 4 year old, obese, Shih-Tzu. She had a 1 month history of inspiratory wheezing. Today, it got acutely worse. Lexi couldn't breathe at all. Every time she tried, a sad little wheeze came out. Her temperature was up to 104.6 due to her obesity, the heat today (90 degrees!), and the fact that she couldn't breathe and thus thermoregulate.
We placed an IV catheter and sedated her so I could examine her upper airway. What I saw was very, very strange. A normal pharynx looks like this:
My patient's glottis (the little tongue at the bottom), as well as the cartilages, and all the area around it, were grossly thickened, misshapen/lumpy, and covered with white plaques. There were white plaques on the bottom of her tongue too. The whole area was diffusely infiltrated with disease.
I've never seen anything like this, and I have no idea what it is. My guesses currently are a yeast overgrowth (she was recently on ciprofloxacin and Simplicef antibiotics after orthopedic surgery), fungal disease (weird manifestation of histo, blasto, asper, or crypto), or cancer. Fortunately, I could help my patient in the short term without knowing exactly what the disease process was. She needed a tracheostomy tube to bypass that upper airway so that she could breathe. Luckily, her airway had just enough room to squeeze an endotracheal tube in, so we were able to control her oxygenation before placing the trach tube. She did very well through the procedure and seemed relieved to be able to breathe afterwards.
Tomorrow, she is going to be scoped and have biopsies and cultures taken of the area, so the end of the story is TBA. I'll get back to ya'll.
The rest of the night was a stream of cases: vaccine reactions, vomiting after insecticide ingestion, a terrible big dog/little dog attack, a dog that was closed in a recliner, and on and on. I ate my dinner FINALLY while standing next to a critical patient in the ICU at 11pm. It was a rough night, especially given that I am spent. Utterly spent.
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