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:
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
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