It all transpired on a burns list. Dr Esmeralda* sought her consultant's advice on a patient who had extensive injuries. She was unsure as to how she would record the patient's blood pressure during the procedure, since both arms & both legs were unspared of what was no doubt the result of another shack fire, or paraffin-revenge of a lover scorned. Her solution would be to put in a radial arterial line, but fixing it in position was once again a problem.
Glancing at the extent of the patient's burns, the Consultant said, "Don't bother with an A-line, just use a BP cuff & put it over the dorsalis pedis artery".
Esmeralda exclaimed, "Oh, can one take a BP there? Amazing, I didn't know."
Consultant, "Of course, one can take a BP anywhere an artery can be circumferentially occluded. It might not work, but at least give it a try. If the cuff fails, then you can always cannulate the artery."
A while later, a mexican wave of raucous laughter had reached the anaesthetics tearoom. The consultant wanted to know what was going on, but he was told to go & look in burns theatre for himself - there was a Darwin Award Nominee at work!
Hanging in the doorframe, Consultant asked if everything was OK.
Esmeralda replied, "I am absolutely amazed! It is working like a charm. It took a while to find the right sized BP cuff, so we are a bit behind schedule, but we are getting beautiful systolic readings. It just doesn't seem to register a diastolic though..."
The Consultant was a little confused. "What size BP cuff did you use? Why a neonatal BP cuff?" when the penny dropped, "Not the dorsalis penis artery, you idiot, dorsalis pedis".
I shudder to think, had there been no systolic reading, how & what she would have done to that poor patient in order to "cannulate the artery".
Esmeralda didn't leave too much longer after that incident. Apparently, she had developed quite a reputation in the city. It wasn't so much her professional- as her social reputation which was to be the deciding factor. Ironically both concerned an organ which apparently doesn't have a diastolic blood pressure.
*apt pseudonym (if you knew her history)
Why I No Longer Blog About Medicine: A Post-Script to and Post-Mortem of this Blog - Through the latter half of my student years and into my first few years as a junior doctor, I kept a blog. In the beginning it was quite general, as blogs ...
6 months ago