I’ll Never Forget the Experience
I was a resident in the ICU and we had a patient recovering from Steven-Johnson Syndrome, which is a rare drug reaction where skin blisters uncontrollably.
At the same time, he had a clotted femoral pseudo-aneurysm that was at risk of bursting and bleeding. Between the afternoon and evening rounds, this patient’s nurse asked me to assess his leg swelling.
His whole body was swollen because of all the blisters and he had fluids he’d been getting for his blood pressure. When I checked his right leg, it did look more swollen than a few hours ago and the skin was worse.
However, the aneurysm was stable on the ultrasound earlier in the day so it didn’t seem like there was much to do other than keep it well dressed and monitored.
A couple of hours later, my co-resident and I are doing our evening rounds as the general surgery team is assessing a few doors down. The leg looks even worse than earlier and is another few centimeters swollen.
Even with the swelling, his vitals are stable and he’s receiving the right treatment. We were scratching our heads when his leg burst. Where the swelling had occurred has now split open and is gushing.
The nurse and my co-resident throw on gloves and apply pressure while I grab a surgical kit and try to find the source. Our team is running down the hall to grab the surgeons who are still evaluating patients. Within two minutes, there’s a small team searching through this man’s leg, looking for the cause.
Another minute or two later and they’ve found they found the ruptured vein. They stopped the bleeding as best they can. I think on the repeat blood work that evening he’d lost maybe 10-20% of his blood in five minutes.
Now we had to treat the infection. This patient was pretty frail and had already had a near-fatal reaction to one class of antibiotics.
I wish I could say it was a happy ending, but his wound became purulent and he developed bacteria in his blood. It was a bad day that got worse with all the other medical problems he was having.
It was just too much and we transferred to palliative. I’ll never forget the experience and know my team kept him as comfortable as possible. Canuck147