Medical accident to patient

According to the World Federation of Societies of Anesthesiologists, "Adrenaline-containing solutions should never be used for infiltration around end-arteries i.e. penis, ring block of fingers or other areas with a terminal vascular supply as the intense vasoconstriction may lead to severe ischemia and necrosis."

In practical terms, that means if a patient is inadvertently given an injection in the toe of an adrenaline-based anesthetic during minor surgery, there is a danger that tissue in the toe may die due to an inadequate supply of oxygen.

My GP made a silly mistake, but to his credit he reacted quickly when he realized something had gone wrong. The biggest clue was the fact that my toe had turned white and didn't bleed when he cut into it. After patching me up and explaining what had happened, he rang a vascular surgeon at Christchurch Hospital, who recommended I be admitted immediately for treatment. My GP then arranged for a nurse to drive me in to A&E. By the time I arrived at the hospital the toe was starting to turn pink again, but my whole left foot was pretty cold, and so the surgeon recommended I go on an intravenous infusion of iloprost, a drug that counteracts the effects of adrenalin by opening up the blood vessels, helping them to carry more blood around the body.

In general iloprost is a well-tolerated drug, but it can cause a lowering of blood pressure, so the person receiving the infusion needs to be closely monitored. So I was taken to a surgical ward (I got a bed in a private room away from all the really sick people) and hooked up to an IV unit on my right arm and a blood pressure monitor on my left. I also had my own personal nurse who came in every half hour or so to check on me.

The main side effects of an iloprost infusion are facial flushing and headaches. The six hours I spent on the infusion were extremely uncomfortable. The headache was the worst thing, but being roused by the damn blood pressure monitor inflating automatically every 15 minutes just as I was dozing off added to the frustration. To make matters worse, I'd stayed up most of the previous night watching TV, so I was already in a pretty sleep-deprived state. Thankfully, once the infusion stopped at around three in the morning the headache disappeared and I was able to sleep until just after seven, when I was woken for breakfast. The surgeon came around to check on me at eight, and then again at eleven, when he told me I was free to go. I'd had Keiko bring my laptop into the hospital the night before, so in the intervening period I'd managed to catch up on a bit of work (see photograph).

It was an extremely anxious 24 hours. The low point was overhearing a nurse at the hospital talking on the telephone about the possible outcomes of not getting a patient on an iloprost infusion quickly enough, one of which is amputation of the appendage concerned. But I'm fine now. And the toe seems to have come through largely unscathed. I went back to my GP today, and he said I should be able to get back into the walking in about a week.

Distance walked today: 0km
Total distance walked since blog began: 78.4km