Chest Pain, Hold the Mayo

Like any ER across the country, we have our share of regulars.  There's the cabal of the usual drunks (no sign of Jack Daniels or Jose Cuervo lately, and I'm told Jim Beam got back on the wagon), Asthma Attack Annie, Drug-Seeking Asshole, and the lovely Mrs. Hypochondriac to name a few.  They're an impressive cast, to be sure, but one of my all-time favorites has to be Chest Pain Johnny.

Johnny stops in every two months or so and every time complains of sudden onset, acute sub-sternal 10/10 crushing chest pain.  He gets brought back to the triage exam room every time for an EKG, which shows abnormalities every time.   Despite being a relatively young guy, Johnny does have a legitimate cardiac history and a pacemaker, and therefore gets the full cardiac work-up every time.  Confident that his complaint will earn him a bed for the next several hours, and if he's lucky, a few days, Johnny usually places his first food tray order at the triage desk.  

The game continues from there, with his initial demands refused while his lab work is still pending.  Those who know Johnny will usually try to wait him out, but we all eventually get worn down by his incessant whining if he doesn't manage to charm some doe-eyed volunteer or random social worker into serving him first.  On an average visit Johnny will score two or three lunches before getting discharged or admitted upstairs for further evaluation.

A couple nights ago, after several hours of dealing with nonstop chanting for food (and personally trying to buy his silence with two box lunches), I wheeled Johnny up to the cardiac floor as he salivated at the thought of room service.  Arriving on the darkened quiet floor shortly after 11pm, Johnny jumped off the stretcher, turned to the nurse, and screamed "Where's the food!?  I'm hungry, I haven't eaten all day!"

It's Called a 'Hangover'

Scene: A well-dressed, professional-looking guy in his late twenties walks up to the triage desk on a relatively busy afternoon with a sheepish look on his face.  

Yuppie: "I, uh... this is kind of embarrassing, but I went out last night and had a little, uh, too much to drink.  But then this morning I woke up, and I feel like really nauseous... and I have a really bad headache.  It's really weird, I don't know what's wrong."

Triage nurse:  "Uh huh."  

Yuppie:  "Yeah, so I have a business meeting in a couple hours, could you guys just sneak me back and let me get some fluids real quick so I could make my appointment?"

Triage nurse:  "Well, there's a decent number of people ahead of you, but we'll try to get you back as soon as we possibly can."

Needless to say, this gentleman with his curious affliction was triaged to the bottom of the pile, and left after an hour or so to face his meeting, hangover and all.

Drive My Car

We had a pair of pretty serious car accidents roll in back-to-back during the parade of traumas the other night.

The first involved an older female driver who sustained minor injuries after crashing her car into another vehicle.  The driver of the second car, a young male, was pretty banged up as well, and sported a textbook seatbelt sign across his abdomen.  Unfortunately, it appeared that the female driver might have syncoped at the wheel, thus causing the crash.  Probably time to take that license away.

Shortly after receiving those two patients, another MVC victim arrived via EMS after being T-boned while driving down a side street.  Apparently another car blew through a stop sign and crashed directly into the victim's driver's side at 50mph.  The patient had basically his entire left side fractured in one way or another, and ended up with a hemo-pneumothorax as well.  I've seen a good number of chest tubes put in, but this was the first time I got to observe one get placed up close, and it was pretty cool to watch.

One of the biggest things I miss most from home is driving, but I'm glad I don't have a car out here.  East Coast drivers are crazy.

Four-Letter Word

No, not that kind.  I get more than enough of those on a daily basis.

This four-letter word belonged to an elderly couple that I took care of last night.  The patient was an older gentleman, accompanied by his wife of over 50 years, who came in complaining of recurring back pain.  I checked in on him a number of times during my shift - EKG, vitals, bed pan, blood draw - and briefly chatted with the pair during each encounter.  They both seemed like wonderful people, and the kind of long-lasting couple rarely seen anymore.

During one of my trips into the room, I turned to the wife and told her she was welcome to step outside while I helped her husband off the bedpan.  She in turn deadpanned, "Why?  It's nothing I haven't cleaned up before."

Later I walked in to find them hard at work on the crossword.  The wife asked if I knew a four letter word for "5th stroke."  Her husband ran through a list of sports that involved strokes, and then received a flash of inspiration.  "What if it's a real stroke, a medical stroke," he asked.  "I haven't had one of those yet."  

The wife considered that for a moment, and then replied, "D-E-A-D.  After your fifth stroke you'll be dead, dear."

Gold Medal Dive

Extremely busy shift last night with 7 major traumas in my first two hours.  Needless to say, the hallways were packed, CT was backed up, and I was constantly moving from one patient to the next.  On top of it all, I had just donated blood before the beginning of my shift, which added a general air of wooziness to the already hectic atmosphere.

At one point during the evening I decided to take a five minute break and moved over to a quieter area of the ER.  Collapsing into a chair, I started to check my email when I noticed a flesh-colored blur out of the corner of my eye.  Thinking I had experienced a hypovolemic hallucination, I turned in time to see what appeared at first glance to be a naked man fall out of the ceiling and land in the middle of this contained, five-bed treatment area.  

Letting out a few choice expletives in surprise, I ran over and found a 20-something year old male (who thankfully was not naked and had on a pair of shorts) lifting himself off the floor as blood trickled down his forehead.  I grabbed some gauze and applied pressure to the lac while a handful of nurses, a resident, and the attending ran over to see what the hell had happened.

Apparently the patient had been brought in for a drug overdose, needed to go to the bathroom, and with both side rails up on the stretcher, decided to dive head first off the end of his stretcher.  

For his effort, he won himself a board and collar, a head and neck CT scan, an X-shaped laceration in the middle of his forehead, and 9.7 from the American judges... but only a 6.5 from the East Germans.

JCAHO and the Amazing Technicolor Dreamcoat

A front page article in the New York Times this morning discussed the standardization of hospital warning band colors for things like allergic reactions, restricted extremities, and DNR status.  I'm all for efforts to improve patient safety, but when they described how blue simply wasn't the right color for DNR bands because they could too readily associated with the phrase "Code Blue" and therefore be confusing, I think the point of over-analyzation had been reached.

The ER where I work has red bands for allergy status, but they don't take the place of communication.  Every time I go to draw blood I ask the patient if I can use that arm, and every time a nurse gives a medication they ask about allergies.  I know that won't work for the confused or unconscious, but it's amazing what you can learn (and what problems you can avoid) by simply talking to your patient.

Not Good

Another ER waiting room death, this time in Canada.

Fish Tales

During a lull in the action the other night, one of the nurses described an episode of Grey's Anatomy that involved a fish swimming up the stream of a guy's urine and lodging itself in his penis.  While I definitely can't top that, I have had two fish tales lately.

The first occurred earlier this summer, and involved a man who had just returned from vacation.  I walked into his darkened room to find him moaning and shivering, with a temperature of 103˚ and a heart rate in the 130s.  Apparently he had been bitten by a fish (he thought a catfish) while swimming, and subsequently developed a nasty infection.  Not the souvenir he was hoping for, I imagine.

The second story unfolded just a couple days ago, when a man walked up to the triage desk with his hand buried under a bundle of blood-stained rags.  The sound of shrieking drew a crowd out to the desk, where the patient had unwrapped the makeshift bandage to reveal a fishing hook caught in his thumb.  The hook itself wasn't too bad - it didn't look too deep and the bleeding was controlled - but the sight of a nearly-severed fish still attached to the hook, spilling its innards out onto the desk was just a little too much for this particular nurse.

And speaking of TV medical dramas, I read that ER will begin it's 15th and final season tonight (it should have ended years ago, but still, I'll miss it...).

Chewbacca

Reading EE's post over at Backboards and Band-Aids today reminded me of my own tale of a good prosthetic gone bad...

A couple months ago I was working a hallway team when the triage nurse wheeled back an out of control male patient performing his best Chewbacca impression for the entertainment of all the truly sick patients.  Not only was he spitting and throwing punches, but he was doing his best to take off somebody's head by swinging his metal leg at anyone who passed by.  

Throwing him into a room, we attempted to calm him down but quickly ended up calling security to help place him in restraints.  As the officers searched him for weapons, they discovered two dime bags and a switchblade in his front pocket, around $900 cash in the back pocket, and a crack pipe stuffed up his sleeve.  Now, three of the four limbs gave us no trouble, but we had the hardest time trying to figure out how to secure the thin metal pole that made up his prosthetic.  The restraint wouldn't close tightly enough to clamp it down, so he ended up having enough slack to move it a few inches off the bed.  

The result was a solid hour of nonstop growling accompanied by the steady beat of a fake leg slammed against the metal stretcher.  Eventually the APRN got fed up and started pushing Narcan until Chewie agreed to knock it off, lest he completely lose his high and then really have something to cry about.

Helter Skelter

With little by means of homework tonight, I thought it might be a good idea to call in for a quick four hours of extra time.  Naively hoping it wouldn't be that busy of a Monday, I even brought a book along with me to see if I could get some studying done in the downtime... a classic rookie mistake.  It's that kind of thinking that inevitably results in me getting slammed.

Passed triage on my way in and saw around twenty charts staked up for patients still waiting to be seen.  Checked the schedule and discovered that I would be the only tech on one half of the ER, covering three patient care teams.  Grateful at least for good nurses to work with, I spent my "princess shift" moving nonstop from one patient to the next.  

Bad asthma attack came in next door to the rule out CVA, both down the hall from the suicidal Motrin overdose.  Moved her out to receive the pre-op patient with abnormal labs, and then got tied up with the possibly septic cancer patient whose pressure would not move out of the 70s.  Another asthma patient snuck in between the pair of elderly ladies given the boot by their nursing homes, both of whom were yelling at each other loud enough to annoy the 25 year old with the bad migraine.  After correctly spotting a-fib on a patient's EKG, I learned from a PA how to apply steri-strips to an older gentleman's sliced finger before wrapping it in tube gauze in sending him on his way.

Needless to say, no time for studying, but still a quick, fun, and hands-on mini-shift after a day stuck in lectures.  And I was even called handsome by a young female schizophrenic, which counts as compliment even if she didn't know what she was saying, right?

I Feel Fine

Interesting article this morning in the Wall Street Journal discussing the recent reduction in healthcare spending by consumers in light of the slowing economy.  Apparently, along with prescription drugs and elective procedures, emergency room visits are being scaled back by penny-pinching patients (as evidenced by Nurse K's recent post, which must have inspired the article).

Apparently what was once considered a recession-proof industry is now taking a hit across the board.  While it may seem that a period of financial strain might help empty some of the waiting room chairs of people with bogus complaints, the article goes on to mention that if anything, this will be a calm before the storm.  Unfortunately, though the patients with knee pain for 16 years might think twice before driving in, those with real medical problems are skipping prescription doses, canceling their doctor's appointments, and putting off necessary procedures.  Which means those who feel fine now and can't afford medical care will simply end up in the ER a few months down the line, flooding the waiting room with patients requiring even more expensive care.

Five-Star Safety Rating

With the sun setting on the era of gigantic, gas-guzzling SUVs, those ultra-compact European SmartCars are rapidly gaining in popularity.  Whenever I see one out on the road, however, I cringe at the thought of Semi-truck vs. SmartCar post-collision carnage.  As environmentally friendly as these vehicles are claimed to be, I have trouble picturing them as safe.

Until last night at least.  We received a patch for an MVC, and readied the trauma room in anticipation of another badly injured patient.  EMS wheeled in a young female, the driver of a SmartCar that had been T-boned and rolled three times before coming to a stop.  Anticipating horrific injuries, I was pleasantly surprised to see that she ended up without a scratch.

Apparently those little cars are really nothing more than glorified roll cages, but what they lack in their carbon footprint I guess they make up for in toughness.

Lightweights

This past weekend we were swamped with an army of Local College newbies who each arrived looking like they were on Death's doorstep while barely blowing over .100 on the breathalyzer.  Though the details changed, the facts remained the same: pale, semi-responsive, moaning in agony, remnants of poorly-cleaned vomit on the face and clothes, accompanied by only slightly less disheveled-looking friend.

Highlights included: 18 year old female with a BAC of .121 accompanied by sobbing friend giving a live play-by-play via cell phone to the girl's parents, who wondered if they should drive up from the next state over; 18 year old male who partied hardy at .134 and thought it would be a good idea to try to throw punches at triage (it wasn't); 17 year old male responsive only to deep sternal rub, whose urine-soaked clothes looked quite expensive.

At least the regular drunks know how to hold their liquor.

Sadly, though, we had a 19 year old female who claimed to only have started drinking four months ago but already showed signs of pancreatitis.  Awful to see somebody that young rapidly throwing their life away.

Baby You're a Rich Man

Sounds of a scuffle out in the ambulance bay drew me away from my hallway team early in the shift last night.  Running over, I saw a well-dressed man trashing about in a stretcher as an increasingly large combination of EMS and ER staff tried to calm him down.  Violent and uncooperative, he was placed in two-point restraints and assigned to my team.

Despite his obvious intoxication (BAC 0.374), he required medical clearance before he could be exiled to the drunk tank.  In situations like these, the triage nurse will often park the patient in the hallway right next to the workstation to encourage a quick eval by the physician.  

As one of our newer residents attempted to perform an exam, some of the following quotations were heard echoing down the halls of the ER:

"Get your filthy hands of my suit!  This is a Burberry!  It costs more than your car!"

"Don't you touch me!  I'm rich!  I make more money in a month than you make in a year!  I'll sue you bastards!"

"I went to Small East Coast Liberal Arts College!  I'm smarter than all of you!  And my house is bigger than yours!"

And, my personal favorite:

"What hospital is this?  Is this Nearby Catholic Hospital!?  I'm a Methodist.  I HATE CATHOLICS!"

Resisting the urge to run home and grab my rosary, I was quite amused when one of the nurses taped a small paperclip cross to the end of his stretcher before wheeling him away to sleep it off.

For You Blue

A while back, Nurse K wrote of a patient whose pain wouldn't let her get out of bed, but somehow arrived in the ER bed-free.  I often have similar experiences with people claiming to be unable to get out of their car.  In most cases, patients who managed to walk themselves into the passenger seat (let alone drive themselves) should be able to walk out again, at least into a wheel chair.  So whenever I'm asked to break my back removing someone from their vehicle, I approach the situation with an elevated level of skepticism. 

The other night I was working triage when a nurse asked me to bring a stretcher out to the waiting room entrance and help a patient out of their car.  Apparently the gentleman's son drove, and claimed his father was unable to walk up to triage.  Managing to avoid rolling my eyes, I wheeled the bed out the doors and found one of our security guards waving me over to a hastily-parked sedan.  Still highly suspicious, I peered into the passenger compartment to ask the patient why he was having trouble getting out of the car, but received no answer.

Because he wasn't breathing.  

Looking at me with panic in his eyes, the gentleman waved his arms frantically.  Yelling at the officer to grab help, I struggled to lift the patient out of the car, over the curb, and onto the stretcher (after managing to undo the seat belt - safety first!).  A few more nurses ran out the door to help, and what ensued was one of those rare moments straight out of ER.  With the patient turning blue on the stretcher, we sprinted through the waiting room and kicked open the sliding doors behind the triage desk.  As we barreled through the main treatment area on our way to the trauma room, the patient started foaming around the mouth.  Before we even parked the stretcher people were cutting off clothes, starting IVs, getting him on the monitor (O2 sat: 79%) and grabbing meds.  After an extremely rapid Rapid Sequence Induction his sats starting climbing and his skin pinked up.  

All in all, a perfectly legitimate example of a patient who required assistance exiting their vehicle.

With a Little Help From My Friends

Working at triage always provides an opportunity for bizarre interactions with any number of unique individuals.  Last night, however, we had a bit of a mystery on our hands:

Guy comes up to the desk and asks our permission to bring his friend out of the car and into the ER.  After being assured that we were okay with that, Guy walks Out-Of-It-Looking Kid up to the chair.  Guy tells us that his 20-something year old friend took a bunch of Tylenol and was now asking funny.  Triage nurse asks the Kid for the number of pills, and is told "a bunch."  Five pills?  Fifty?  "I don't remember."  Was he trying to hurt himself?  "I don't feel good."

Then, it started to get weird.

After several minutes of questioning interrupted by the occasional vomiting, we learned that the Kid was visiting the Guy from California, and that he had taken the pills sometime in the early evening.  Guy came home from work around 2130, but didn't bring the Kid in until 0130.  Guy claimed to know nothing about the Kid's background, had no idea how many Tylenol were in the house, and didn't have any contact information for the Kid's family.  As soon as we wheeled over a stretcher, the Guy disappeared.  I stayed late enough to see that the Kid's acetaminophen level was through the roof, but not long enough to see the friend return.

Now, something tells me that we didn't get the full story on this one.

Listen and Repeat

Following Shadowfax's post on overuse of the ER, an interesting article appeared in New York Times this morning about ER patient confusion over their discharge orders.

In some ways, I can see both sides of the argument.  I've been in patients' rooms pulling IVs and taking them off the monitor when a harried resident steps in and within 30 seconds or less explains there's nothing wrong, recommends followup with a PCP, hands them discharge orders, asks about questions and leaves.

On the other hand, it's equally if not more common for a patient, in a rush to leave after waiting for hours, to simply tune out the doctor, sign whatever discharge paperwork they're handed, and leave it at the bedside as they walk out.  Patients who don't present with true "emergencies" still often have underlying medical problems that simply can't be fixed in the ER, but many refuse to follow their instructions or make the effort to find primary care - something beyond the doctor's control.  I have trouble seeing how it should become the physician's responsibility to quiz the patient on their understanding after already taking the time to talk with them and providing written instructions.  

Regardless of what side of the argument you fall on, however, I think most people would agree that unlike the woman cited in the article, a diagnosis of PID should be enough to get the patient's attention.

Monday Morning Quarterback

Entered an exam room to log-roll an elderly fall victim while the resident checked the c-spine.  Reaching over the patient, I grabbed the opposite shoulder and hip as I usually do.  The moment I laid my hands on the poor guy, he started screaming loudly.  Looking down, I noticed the far leg was a couple inches shorter than the near one, and that the foot had rotated to face out rather than forward. 

Recapping, that'd be...

Textbook Sign of a Hip Fracture: 1

My Powers of Observation: 0

It Ain't Over 'Til It's Over

I've seen plenty of suicidal people work their way through the ER, the vast majority of whom aren't successful.  One young girl, however, recently got as close as you possibly can.  

EMS found her with slit wrists bleeding into a full bathtub.  She was assumed to be dead on scene, but someone eventually managed to find a pulse (you aren't dead until you're warm and dead).  Rushed to the ED, she arrived in cardiac arrest, pale, freezing to the touch with a core temperature in the 80s.  Compressions, meds, defibrillation x 3, and an inflatable rewarming blanket later, she regained her pulse and rejoined the living.  Despite intense effort by the ED staff, the ICU initially hesitated over admission, claiming that "these kinds of patients" don't do well.  Our attending very quickly had them change their minds, and I learned afterwards that she walked out of the hospital only a few days later.

Just further proof that when you're number's up, it's up... but if it's not, there's nothing you can do about it.  After dealing with that code a while back, it was nice to see such a heroic save.  Hopefully, she gets the help she needs and makes the best of her miraculous second chance.

TGIF II

Another Friday night in the Big City...

Drunk Asshole arrives in police custody after slicing his palm open on God knows what.  Sutures to the hand.  Tried to make friends by throwing his full urinal across the room.

Drunk Punk arrives via EMS after an evening spent minding his own business, ambling quietly along the Big City streets helping old ladies cross streets, when suddenly, for no reason whatsoever, two dudes came out of nowhere and just jumped him.  Sutures to the head.  Tried to make friends by ripping of his c-collar and running for the door.  

Drunk Player arrives with entourage after trying to work his game on a girl whose ex-boyfriend just happened seated further down the bar.  Sutures to the nose and multiple facial lacs after the broken beer bottle shards were removed.  Had more than enough friends already.

And finally...

A Sober Jogger who ran into oncoming traffic, was struck by a car, had a GCS of 3 in the field but perked up in transport and earned some facial sutures before spending the night in the ICU with some minor internal injuries.

ER Vocabulary Lesson

hot mess [hot•mess] -noun

1. When one looks terrible, or acts in such a way to make them unpleasant to be around.

2. A boisterous and uncooperative patient, often brought to the ER against their will as a result of self-destructive behavior, who inevitably creates a scene while trying to leave.

-ex. That hot mess who crashed her car into a semi-truck while doped up on Percocets just received some Narcan and is now screaming, swearing, spitting, ripping out her IV, and, oh yeah, stripping her gown off and running down the hallway naked.

-Antonym: The 54 year old female with recently-diagnosed leukemia complaining of severe abdominal pain and headache stuck in the room next to the hot mess.

A Simple Request

Dear Citizens of the Big City,

On nights when I have to wake for 0830 classes, could you kindly refrain from revving your engines, crashing your cars, blasting your music, getting into fights, and shouting obscenities at each other directly below my bedroom window?

On nights when I work until 0400, however, please feel free to participate in any of the above mentioned activities; I look forward to seeing you in the ER.

Sincerely yours,

Second Shift

Some (Re)Assembly Required

Poked my head into the trauma bay the other night after hearing an overhead page for a full trauma.  Listening to the tail end of the EMS report as the patient was transfered to our stretcher, I learned that he was a (surprise!) no helmet motorcyclist who ended up on the losing side of a collision with a semi-truck.

Now, to be fair, I was standing at the back of the trauma room and only half-heartedly paying attention.  I was not present when the patient arrived, and my view of the stretcher was blocked by the crowd of people surrounding it, preventing me from noticing that something fairly important was missing from the picture.  So when the paramedics returned a few moments later carrying a large bundle of sheets and pads, I had no reason not to lift the cover of the linen cart and motion for them to drop their bundle in with the rest of the trash.

Imagine my expression, then, after the medic stared at me for a second before explaining, "No, this is the guy's leg."

Peering over the doctors' shoulders, I noticed that patient was in fact missing his left leg below the knee, and promptly closed the linen cart.

Dukes of Hazard

Came across this chart while reading the Economist this morning and was impressed that over half of these causes of death have made their way through the ER since I started working there.  Of those, only a handful have actually killed anyone in my presence (though the guy who was electrocuted on his roof while cleaning out his aluminum gutters with a metal rake during a lightning storm was clearly asking for it).

Still, given the odds, I wonder if I should invest in some flame-retardant pajamas...

Hell Hath No Fury

Overhead page calls a full trauma five minutes out, and the trauma room begins to fill up.  Nurses, techs, ER docs and trauma surgeons shuffle in, Respiratory arrives, and X-ray barrels through with their portable machine.  The EMS patch provided few details beyond the stab wound to the lower back, so everyone was curious about how serious it would turn out to be.

After those five minutes had stretched to their inevitable ten, EMS arrived with a middle-aged gentleman sitting upright on the ambulance gurney laughing with the medics.  Trauma assessment revealed a small, one inch stab would to the right flank and a small bruise to the forehead.  With a somewhat embarrassed demeanor, the patient recounted how he had been arguing with his wife in the kitchen before she decided enough was enough and stabbed him with steak knife and hit him in the head with her frying pan.

Breaking News

This just in: waiting times in ERs across the country are increasing.

Shockingly, "researchers also found that there has not been any recent increases in the number of patients arriving by ambulance, or in the number of cases considered to be true emergencies."

Does that include my guy complaining of right knee pain for the past 10 years?

Tough Code

I don't know if this makes me seem callous, but I'm usually able to remain pretty well detached during codes.  Last week, however, we had one that got to me.  Maybe it was watching the attending cry afterwards, maybe it was the exhaustion that came from keeping up compressions, but this one was tough.

Walked into work the other night, and as I was waiting to punch in I helped transfer a patient onto a stretcher as she made her way back from the waiting room.  A few minutes later, I was stocking supplies at the beginning of my shift when someone grabbed me and said they needed an extra set of hands for a code.  I ran over and joined 15 people crowded around the woman I had just brought in: middle-aged female who came in complaining of shortness of breath.  She had been anxious and yelling only a few minutes ago, but now was unable to maintain a pulse without compressions.  Fluid bags were squeezed in, a central line started, transcutaeous pacing and an A-line attempted. Cycling through rounds of compressions with a few other techs, I had sweat running down my forehead and my arms were exhausted.  We were at it for over an hour.

Most times a code comes in arresting after a major trauma, or is sick and elderly, or has already been down for an extended period of time.  Most times I don't get to see the person walk in, help them on a stretcher or listen to them talk before I'm pounding on their chest with their lifeless eyes staring back up at me.  This was the first time I had someone walk in, code, and die in front of me.  As I stuck around afterwards to help clean up the body, I overheard that she had a history of cardiac problems, but had stopped taking certain meds while trying to get pregnant, and that's when it hit me.  I had tried to remain detached, but by that point it really hit me.  

After taking a few minutes to decompress, I got back to work.  Thankfully, there were very few patients for the rest of the night, and everything remained quiet.

It's Only a Flesh Wound

Somehow the most interesting cases always seem to come in on my nights off.  

Case in point: a guy shot himself in the penis the other night.  

A definitive version of how this event unfolded never surfaced, but my sources speculate that it occurred while the unfortunate gentleman was reaching for his ill-placed piece.  Don't worry, though, it wasn't through and through.  The bullet merely grazed his penis.

I now have a very difficult story to top at cocktail parties. 

Back to School

I'm taking a course on Bioethics and Law this semester, and the topic of the first lecture this morning just happened to be EMTALA, the unfunded federal mandate requiring medical screening exams and stabilization of every patient that walks into an Emergency Department.  The case itself was an interesting one that I'm too young to remember; a 1993 battle between the mother of Baby K, a permanently unconscious anencephalic infant with a very limited life expectancy, and the treating hospital over whether the child should continue to receive heroic measures instead of palliative care during every respiratory crisis.  Ultimately, a ruling was issued in favor of the mother, and Baby K lived to reach two and half years old.  It was a great discussion about an unintended consequence of EMTALA, and will hopefully signal the start to a great semester.  

When I head into work tonight, however, I'm sure to face several equally unintended, but far less dramatic, consequences of EMTALA...

In Other News

Part of transitioning from summer back to the school year means I'm back to following the news more closely.  It's a weird feeling to read about patients who were brought to our ER in the papers the next morning.  We've had a couple of pretty major traumas lately, and I'm always intrigued to see how the stories are handled by the press.  Most of the time the coverage is disappointingly light, and sometimes appears to completely contradict the information we receive from EMS.  With gunshot victims in particular, I always want to learn more about what happened, but more often than not very little information comes out.  Still, it's a unique perspective to read that the victim "was rushed to Big City Hospital's ER" and know that I was there when it happened.  

A Real Cliffhanger

We had a guy who fell off a cliff last night.  True story.  Apparently he was out hiking, just might have had a couple beers and smoked some pot, and next thing you know, he was 15 feet closer to the center of the Earth than when he started.  He had been missing for hours, but managed to call 911 on his cell phone, only to pass out before telling the dispatcher his location.  Search and Rescue eventually found him, and airlifted him over to our trauma room.  Souvenirs from the adventure include an open tib-fib fracture, a broken elbow, and a head bleed to top it all off.