Sunday, November 9, 2008

The Plot Thickens

There are some nights in the ED where it feels like more of our efforts are spent on figuring out a patient's story than actually treating the conditions that brought them to us.  

Working trauma last night, I listened in as EMS patched for an incoming older male patient with several abrasions and lacerations.  Only after he arrived in the ambulance bay did we learn that, in addition to the bumps and scrapes, he had been found unresponsive by the side of the road, and was currently confused an unable to follow commands.  Since those are generally considered bad signs, Mystery Man was triaged as a minor trauma and brought to our trauma bay.  As the ED resident began his survey, he discovered that Mystery Man had a GCS of 8, sluggish pupils, and weak, shallow respirations.  Quickly upgraded to a major trauma, he was intubated while an NG tube and foley cath were inserted before he was placed on a ventilator and rushed up to the ICU.  After we got him upstairs, we could only wonder what happened to him - assault, thrown from a car, fall resulting from a seizure?  EMS had nothing, and police were investigating.

Meanwhile, a case of less mysterious origin was unfolding out in the hallway.  A young female arrived from lockup in police custody complaining of sudden onset, crushing 10/10 chest pain and a stomach ache.  And tingling in her foot.  And jaw pain.  I bet her elbow even hurt when the weather changed.  With a normal EKG and negative cardiac and abdominal labs, however, she was diagnosed with acute incarceritis secondary to jaw pain status-post ass-whooping, and discharged back to jail.

Searching for an update on Mystery Man's status later in the night, I learned from the trauma team that his altered mental status, labored breathing, and sluggish gaze were the result of nothing more than being really, really drunk (BAC .390).  He was subsequently extubated and allowed to sleep it off.

Mysteries solved.

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