Completely Under Construction

The colors may be whack for a little while, but everything will be great in a bit. Please stay tuned.

Sick Patients

The word "sick" in emergency medicine carries a completely different connotation than it does in every day life. When you or I say that we're sick, we usually mean that we have a cold or flu, or at worst, pneumonia or even *gasp!* cancer. When you hear someone in the ER say, "that guy is really sick", it means they're probably going to die if not treated immediately, and even then, there's no guarantee. Sunday night, we had some really sick patients.

First we had a relatively young guy, around 57, come in because he became weak on one side, and wasn't communicating appropriately. When he came in he was wearing Mariachi pants, so it looked like he had been at some kind of festivity when his symptoms started. About 20 minutes after he came in, they had to intubate him because he had lost the ability to swallow effectively and wasn't breathing well. His CT showed a huge bleed in his brain, but it looked like they were going to be able to control it and he would end up being ok.

The second guy that came in was an 82 year old doctor who was still practicing medicine. He had had some sort of cardiac event, and had to be shocked a couple of time in the ambulance on the way over. Once he got to us, they did CPR for a little bit before they got his heart to begin beating again. After intubating and stabilizing him, he began to wake up and seemed vaguely aware of what the situation was. His wife and son were there with him, and his other son, also a doctor, was calling all night to get status updates. Right as they were about to take him down to CT, he started having problems with the breathing tube, but they got him stable enough to go down for his scans before they sent him to the ICU. It looks like he'll make it, but I'm not sure what the long-term prognosis will be.

Almost as soon as we got the second sick patient off the floor, we got another stroke patient. The phone report said that he had been complaining to his family of a headache for about an hour, and that all of a sudden he stopped responding to them, so they called 911. In the ambulance on the way, he vomited, and his blood pressure was realllllly high. He had become completely unresponsive in the ambulance, and they had to intubate him as soon as he arrived in the ER. His head CT showed a huge, uncorrectable bleed, and it wasn't long until his vital signs started going off-course. Though he was stable enough for transport when we received his bed assignment, the nurses transporting him were practically running while pushing the gurney, because they weren't sure how long it was going to be until he crashed. (And there's nothing worse than coding a patient while in the elevator.)

Around 5:30AM I got a phone call from a man at a nursing home who wanted to transfer over a patient. I transferred him to the transfer center (ironic, huh), and not long after got a call from the transfer center, asking to speak with a physician so that they could accept the patient. A very short time after that we got a call on the BLS phone regarding a patient we would be receiving who was in respiratory distress. Everyone was a little confused as to why a patient with respiratory distress would be brought via BLS, but there wasn't much to do but wait for them and hope it wasn't actually true. When the patient arrived, we realized that this patient was in fact the patient that the nursing home had called about regarding a transfer. The thing is, they called the ambulance and had him on his way before they even called asking if we would accept him. THEN, homeboy from the nursing home called back and wanted to give report to our charge nurse regarding the patient. The charge nurse really laid into him, because that's not the way that these things should go at all, and she told him that his report was basically useless now that the patient was here and we could see all of his paperwork.

Besides the procedural drama, this patient was really sick, too. He was in his late 70's, and was a DNR. It looked like he had some kind of long term illness (obviously, he was in a care facility), but I didn't look into what it was. He had a DNR, and was actually in respiratory distress, but there wasn't much we could do for him except to put an oxygen mask on him. His oxygen saturation was at 40% (normal is 100%), and that was with the oxygen mask. We all thought that he was going to code before the end of the shift, but he was still there when I left.

THEN, we got an ALS call about a 1 month old baby that had had an ALTE; an apparent life-threatening event. These are kind of vague episodes that can be caused by a few different things, but apparently this baby began choking and stopped breathing and turned bluish for a short period. By the time the paramedics brought her in, she was basically fine, and they were just going to need to run tests to see if they could figure out what had happened. (Most likely a seizure.) We weren't sure why they were bringing her to us since we're not a children's hospital, and as soon as she arrived and was initially checked out, we began the process of transferring her to the children's hospital.

Among the other, less sick patients we had that night were:

• Mid 60's husband and wife rollover car accident trauma patients
• Mid 20's prisoner who was involved in a fight at the prison
• Mid 30's man who was shot twice in the chest but was well enough to leave the hospital after the cops took his prints

It was a pretty busy night.... for a Sunday.

I took part in my first mass casualty incident (MCI) a couple of nights ago. I arrived at work early to leisurely eat dinner after being at school all day, and as soon as I sat down we got the call. Apparently it was a bus vs. minivan vs. car., where the driver of the minivan was drunk. 12 people in total were taken to area hospitals, and 4 of them (later 5) came to us.

The first one was the worst of all of those injured. She turned out to have a broken pelvis and a pretty messed up pinky. I *think* she was in the minivan, but I was too busy to gossip with the cops.

The driver of the minivan, the cause of the accident, was also one of our patients, but I didn't find this out until I read the newspaper article today and saw his name. I really don't remember what his or the other guy's injuries were.

A few hours later, we got a call from another area hospital saying that they had received a patient from txhe accident, but after doing CT scans they found that he had worse injuries than they could care for, so they were transferring him over.

We had to go "down" to incoming ambulance runs for a while afterward, because the trauma team was tied up, and we just didn't have any beds available.

When we did open back up to basic ambulance runs, though, we got a real winner. The call said 65 y/o Male with a 1/2 inch laceration to his testicle. When they brought him in, he was sitting on the gurney with no pants on cupping himself with both hands, telling the EMTs a joke that ended with, "so then he says, 'Hey, you're getting it all over my shoes!' "

OF COURSE they put this dude in the bed right next to the desk, so I have to listen to his "jokes" and banter the entire time he's there. Even better is that he's hard of hearing, so everything he said was basically yelled, and if you didn't answer him, he just kept yelling. At one point he accused us of stealing his backpack, which was right in front of him, and at another, we supposedly stole his sandals, which were again, right there. He took the opportunity to tell every nurse that walked passed that he cut his "ball", and when the doctor went to examine him, he said he was itching, and scratched too hard. After he realized he was bleeding, he took a kitchen knife and heated it on the stove, and attempted to "cauterize" himself, which apparently only made matters worse (not surprising). So the doc said he was fine, gave him some ointment, and told him to wait for his discharge paperworks. After wandering around and being asked to stay in his area several times, he started yelling at one of the techs and pointing his finger at him, saying, "You don't tell me what to do!!! I'm tired of sitting!!" Well, sir, if you didn't cut your ball, you wouldn't be in this situation. We almost called security to come and intimidate him into either calming down or flipping out enough to be escorted away, but his paperwork was finally ready, and we sent him home.

Great night....

Busy Busy Night

Here's a quick rundown of how badly I got my ass kicked at work last night (all of us did, really). Not only was I alone because the other clerk called in sick, but it was unusually busy as soon as we clocked in. Here are the trauma patients we had, in no particular order***:

~35 y/o Male; Auto vs Peds. Homeboy was crossing the street holding his dog in his arms when he was hit by a car going about 40 mph. He had one leg broken, one arm broken, and was just all around beat up. To make matters worse, he's a heart patient, so he's on a blood thinner which made him bleed from every little scratch. Needless to say it was a mess. No word on the condition of the dog, as far as the police knew.

~53 y/o Female; TC. Her car was T-boned and subsequently rolled over. She was actually pretty fine. They had to cut the roof of the car off to get her out, but she was discharged just a few hours after she came in.

~9 y/o Female; Arm Pain. This little girl was playing on the jungle gym when she felt a pop in her neck and started losing strength in her arm. Her parents originally took her to a different hospital, but she needed a higher level of care, so she needed to be transferred. Since our hospital doesn't have a real pediatrics inpatient wing, she ideally would have gone to the children's hospital. The children's hospital, however, insisted that this was a trauma patient, and that they don't accept trauma patients. There was no real "trauma" to the kid, but as one of our docs put it, "if there's kinetic energy within 10 feet of them, the children's hospital considers it trauma." I have no idea what happened to her after we admitted her, but I'm sure she was going to be seen by a neurologist to figure out what was happening.

~25 y/o Male; Mult dog bites. Dog bites to arm, rubber bullet to abdomen. You guessed it: this guy was running from the cops, and they sent the K-9 after him. When the paramedics called to alert us that he was coming, they described the dog bite injury as looking like "hamburger meat." This dude was a real winner with swastika tattoos and other such gang-related nonsense going on. He was under arrest when he was brought in, and discharged to jail after he was treated.

~17 y/o Male; Stab wounds x 4. Homeboy was stabbed in the back 4 times. Stabbed in the back!! Classic betrayal! He originally went to a different ER, but was transferred to us for a higher level of care. He was relatively ok. He'll make it.

~35 y/o Male; Fall from 2 stories. He was drunk as all get out, and we're still shady on the details regarding his "fall," but the experience left him paralyzed. He shattered part of his spine, and according to the CT report there was "significant height loss."

~17 y/o Male; TC. He was the restrained front-seat passenger in a car of 4 other unrestrained passengers. He had hit his head pretty hard, and was disoriented because of it. He'll be fine, but he was admitted to the hospital.

~15 y/o Female; TC. Same accident as the 17 y/o above. She was in the back seat, we believe. She had close to the same injuries as the guy did, but she wasn't wearing her seatbelt. (3 other people from the same car walked in to be treated as non-traumas. Apparently their car and another car were street racing and going 70mph on surface streets. Winners.)

~22 y/o Female; Car vs. Tree. She was the unrestrained passenger in an accident that only involved her and the driver (and the tree). She hit her head on the windshield and had to be extricated from the car. She was completely unresponsive, but had ok vital signs when she came in. They put two chest tubes into her because he lungs had collapsed, and after she was transported to the ICU, her blood pressure started dropping. Not too long later, we heard them call a Code Blue in the ICU, then another, then the coroner called asking me which room she had been taken to. The driver of the car was uninjured, and was taken to jail from the scene.

All of these traumas were in addition to the regular flow of patients that we get coming in through the waiting room and coming in via ambulance that aren't considered traumas.

After all of this, it was 4AM, and I was finally able to start on the piles and piles and piles of charts that had been stacking up throughout the night. I only got about half of them done by the time day shift came in, but I don't feel too bad, because day shift is WAY slower than nights, and that just means I gave them something to keep themselves occupied.


(*** In fact they are in order of arrival. I didn't think I'd be able to remember them exactly in order, but I did.)

I give it a month...

I'll have to review current HIPAA rules before posting any patient stories from work, but I'm sure as long as I avoid identifying information, I can make this interesting.