Thursday, December 31, 2009

Happy New Year!

To everyone planning to ring in the New Year tonight, a word of advice based on a recent patient of mine: if you're an 18 year old punk who weighs a buck twenty tops, it's probably not a good idea to pick a fight with a bouncer (and lose), only to later pick a fight with a cop (and lose), and then finally pick a fight with the medic trying to treat you.

Stay safe, and remember the holidays are much more fun to celebrate outside the ER.

Tuesday, December 29, 2009

One Way To Get Attention

Feel like you're lost in the shuffle in a busy ER? Try firing a flare gun at the ceiling. You'll definitely get attention, but probably not the kind you wanted.

Monday, December 28, 2009

Four More Years

Love being home, love catching up with the family, love being accepted to med school. The acceptance, however, does not mean that I am capable of diagnosing the perplexing array of symptoms experienced by assorted relatives. Nor does it mean that I hold the solution to health care reform.

Sorry guys.

Sunday, December 27, 2009

Zombie Epidemiology

As I've mentioned before, we in the Big City ED have some of our best people working on Zombie preparedness. It's about time the New York Times took notice.

Friday, December 25, 2009

Wednesday, December 23, 2009

Home For the Holidays

Safely back home with friends and family for a few days to celebrate the holidays. Good luck to everyone still traveling (if you're stranded, I now know of at least one airport that will gladly sell you a $35 H1N1 vaccine while you wait)!

Tuesday, December 22, 2009

It's The Most Wonderful Time of the Year

You know the Christmas season must be upon us when the freezing cold EtOHers help spread some holiday cheer by offering the ED staff a spare pint of Dubra.

Monday, December 21, 2009

We Three Kings

Competition in the category for Best Presentation to the Big City ED Triage Desk was particularly fierce this weekend, but it is my honor to give you the three finalists...

Myrrh goes to the middle-aged gentlemen who performed a rambling rendition of every blood pressure reading he had ever taken. The saga unfolded something along the lines of "Well years ago a doctor told me my blood pressure was high but then it wasn't for a while until I checked it at a CVS once and I got worried so they started me on, uh, Lisin... um, Lisino, Linsinopoo, but then I stopped taking it," and continued until I asked him what he came to the ED for. His answer? A rash.

Runner up, Frankincense, goes to the dude who ran up to the desk with his finger covered under a large wad of tissues. Sobbing and shaking, he insisted upon sitting on his finger "to maintain the pressure." As the nurse explained that we needed to see the laceration for him to be triaged, I promised to have a large amount of gauze standing by should he have somehow nicked the critical 4th digit artery. Armed with a kling wrap to tie off the bleeder in one hand, I used my other to unwrap sheet after sheet of tissue until I discovered... what appeared to be a mild paper cut.

The Gold medal for Best Presentation to the Big City ED Triage Desk, however, goes to my friend, the Fellow with a Bunion. His award-winning performance went something like this:

FwaB: "Yeah, this has been really hurting for several months now."

RN: "It looks like a bunion, sir."

FwaB: "Is it serious?"

RN: "It's not an emergency."

FwaB: "Well, can somebody take a look at it?"

RN: "You're welcome to wait - it'll probably be around 3 hours - but there's nothing we'll be able to do for a bunion in the emergency department, sir. You'll need to make an appointment with your doctor."

Fwab: "Shouldn't I get an MRI or a CT scan, you know, since I'm here?"

Pure gold.

Sunday, December 20, 2009

Blue Christmas

I don't envy the hospital Chaplain. There are few things worse than watching a family holding each other, sobbing, as they grapple with losing a loved one so close to Christmas.

My thoughts are with them.

Saturday, December 19, 2009

Bah Humbug

Call me an ER Scrooge, but I still firmly believe that if you're well enough to text/tweet/facebook/whatever your local emergency room to determine how long the wait is, you're not having an emergency. Nor do I think you should be able to pay a service to hold your place in line while you wait at home, as this LA Times article describes.

Emergency Room. Not the Let's-See-If-I-Can-Fit-This-In-Between-Yoga-Lessons-And-American-Idol Room.

Hell No

I'm sorry, 95-pound-optho resident. I'm sure that your super-specific, one-of-a-kind, really expensive, unique type of forceps is awfully important to you. I sense the regret you feel from accidentally dropping it in the sharps box. I even wish there was a way I could help you retrieve it.

But did you really just ask me to try to fit my hand inside the container filled with used needles to fish it out?

Really?

Friday, December 18, 2009

Hand Hygiene

While the ED is still working towards 100% compliance with our hand hygiene goals, at least Hospital Epidemiology can be glad our docs aren't covered in rat shit.

Family Matters

She was septic.

Recovering from major surgery and a cardiac arrest earlier this year, she was hypotensive, respiratory rate in the upper 30s, oxygen sat in the 80s. COPD, bilateral effusions, altered mental status.

As I leaned over her to take a temperature, I could hear her whispering about how tired she was.

It didn't take long for her sats to drop into the 60s, buying her a tube and a ventilator. Her daughter watched from across the hall, crying silently.

There wasn't much I could do for the patient, though someday I hope to be the one intubating and starting the central line. For her daughter, though, I was able to find a chair, a glass of water, and a phone for her to call family while trying to explain what was happening.

It wasn't much, but as she grabbed my hand and thanked me, it felt like enough.

Thursday, December 17, 2009

Sláinte

To the absolutely delightful patient from last night with a wonderful Irish brogue, thanks for a great conversation and for being such a pleasure to take care of. You made my night!

Tuesday, December 15, 2009

Fiiive Blood Gas Kits?

KeepBreathing has started the Christmas countdown with a very respiratory-themed rendition of the Twelve Days of Christmas.

Go partake in the merriment while I down more cold remedies in the hopes of surviving my final papers and exams.

Monday, December 14, 2009

All I Want for Christmas is Clear Sinuses

Sick with a nasty, lingering cold that makes me look like Second Shift, the red-nosed ER tech.

Congested though I may be, I have thus far resisted the urge to march down to the ED, cough at people for hours in the waiting room, and demand a Z-pack for my viral illness because my next-door neighbor's cousin's sister once recovered from a cold after getting antibiotics.

Instead I just stay home in misery, fighting antibiotic resistance one Kleenex at a time.

Sunday, December 13, 2009

Buzz Kill

Pt talking on her cell phone: "What's with them not letting us smoke around here?"

Saturday, December 12, 2009

Why Can't We Be Friends?

It feels like hardly a week goes by when a patient doesn't threaten to kill/beat up/"get" me.

When I first started it was a little unsettling, but these days I completely ignore it. Most of the patients who make these threats are emotional, sick or injured, under the influence of their chemical of choice, or already in custody.

In short, I've accepted it as part of the job. I don't leave the hospital looking over my shoulder.

But then every so often a story like this comes along, in which an ER patient is arrested for making threats against the staff. What catches my attention isn't that somebody would threaten to kill the very ER workers they turn to for help, but that the person is actually arrested for it.

I guess I just forget that in the real world, it isn't acceptable to threaten to kill someone. Go figure.

Friday, December 11, 2009

Too True

The hilarious guys behind Indifferential Diagnosis have put together a "best of" post. If you haven't visited their blog, you should.

If you don't believe me, check out their all-too-true depiction of EM:

Thursday, December 10, 2009

Pink Gloves

If you're not one of the four and a half million people who have already watched this video, I hope you enjoy it as much as I did!


Raindrops Keep Falling on My Head

Looking at the schedule, I found that I was assigned to the trauma bay for the first time since before Thanksgiving, and felt a quiet unease tremble deep inside me.

Looking at the trauma bay, I found the room spotlessly clean and fully stocked, and a suffocating sense of foreboding settled in.

Looking at the day shift trauma tech, I found that there had not been a single trauma code in 12 hours, and I could practically see the lights dim as the gathering storm approached.

Wondering when, not if, the onslaught would begin, I moved to wipe down a used set of monitor leads. As I reached for the BP cuff not 5 minutes from when I punched in, I turned over my shoulder to find medics doing compressions on a patient with a blue tinge.

No patch, not even an overage page that a code had arrived - they were just there. I took over compressions as the nurses and docs rushed in, and we went all out for the next 40 minutes. Epi, atropine, defib x 5. Actually managed to get a few organized complexes in between the V-fib and PEA, but ended up having to call it. After cleaning up, I was asked to help move a patient out of his car, and arrived to find that both the outside and inside of the vehicle were completely covered in vomit.

My name is Second Shift, and I am a black cloud.

Wednesday, December 9, 2009

Patients Say the Darndest Things

Pt's Husband: "Boy it's crowded. Bet you guys get a lot of folks without insurance."

SS: "We get a lot of folks with insurance, too. We take everyone."

Pt: "We have insurance, but when we called our doctor he said he couldn't see us so we should just go to the ER."

...And that's the problem. Many people assume that ER overcrowding is driven mainly by patients lacking health insurance who have nowhere else to turn. While we certainly see large numbers of uninsured patients, we also have large numbers of insured patients filling up the waiting room as well.

Whether these patients can't schedule a timely appointment with their own doctor, or simply prefer the ability to show up at the ER whenever they feel like it, I can't say. But as Whitecoat is fond of reminding us, insurance doesn't equal access.

Until the primary care system gets fixed, I'm betting packed waiting rooms and patients lining the hallway won't be going away any time soon.

Tuesday, December 8, 2009

Freudian Slip

MD: "I'm going to do a rectal exam on the patient in Bed 3." [walks away]

Secretary: "Where did the resident go?"

RN: "Oh he's in the middle of a patient right now."

Monday, December 7, 2009

Wannabe MD

I've been completely blown away by the amount of well wishing I've received in the days since I learned of my acceptance to medical school. The ED has always felt like a large (admittedly dysfunctional) family, but I am still extraordinarily grateful for all the cards, hugs, and hive fives.

Now that I've been accepted, the docs and nurses are going out of their way to teach me things before I start next August.

During a rare slow patch over the weekend, an intern, a few nurses, and I were hanging around the workstation. To the handful of patients stuck waiting for results, the scene must have appeared a bit odd. There I sat, eye level with an orange that rested on the counter, meticulously practicing my nascent suturing skills. Later, the intern and I swapped veins as we practiced starting IVs on each other under the nurses' skillful guidance.

Sure, it may have looked like Amateur Hour, but everyone has to start somewhere. And besides, we already have our best people working on more important matters.

Sunday, December 6, 2009

Future Leaders of America

Lost count of the number of drunk, sloppy, tragic, vomit-covered, sobbing, bro-tastic, bile-stained and/or belligerent underage college students who paid the ED a visit this weekend.

After the umpteenth "Yes you're drunk no you can't leave yes you have to breathalyze no we're not the cops yes this sucks no you shouldn't say that about peoples' mothers" conversation of the evening, they all start to blend together.

Except of course the nearly unresponsive girl whose father was an ED attending at Out of State Hospital and drove a considerable distance to pick his daughter up. He must have been so proud.

Saturday, December 5, 2009

Extreme EM

In my more idealistic moments, I often imagine myself working as an emergency physician for Doctors Without Borders at some point in the future (i.e. decades from now when I finally pay off my student debt).

While in one of my "save the world" moods recently, I came across the blog of an ER doc doing exactly that - working for MSF in Pakistan. Makes the chaos of the Big City ED seem pretty tame by comparison.

Friday, December 4, 2009

You Know You're a Frequent Flyer When...

...you comment on our recent change in blood pressure cuff manufacturer.

And you express a strong preference for the previous brand.

Thursday, December 3, 2009

The Doctor Will Be With You Shortly

SS: "Hi, sir. My name is Second Shift, I'm one of the techs. I'm going to get you changed into a gown, hooked up to the monitor, and run an EKG while we're waiting for the nurse and doctor to step in. We'll see if we can help you out with your [non-life threatening condition]."

Pt's wife: "We called ahead. Why isn't Dr. Bigwig waiting for us? You need to page Dr. Bigwig for a consult stat, and he needs this this and that done right away, and here's a list of labs he needs drawn immediately."

SS: "Okay, that's something you'll want to speak with the doctor about. In the meantime, sir, I'm going to help you change and get you all connected."

Pt's wife: "I'm sorry, you must not understand. I'm not some average family member... I'm on faculty at the med school."

SS: "Oh, that's nice. I'm still going to change him into a gown, put him on the monitor, and get an EKG."

Look, I don't care if you're the bloody Queen of England, I'm just a tech. Every patient arriving in the critical care area gets and EKG and thrown on an monitor. People who get paid my hourly rate don't order procedures or consult Dr. Bigwig. That's the job of the person in the white coat. She'll be with you as soon as she's done intubating the dying person in the next bed.

Wednesday, December 2, 2009

Baby It's Cold Outside

Now that December has arrived, cold weather can't be far behind. Looking for a good deed to perform this holiday season?

Every winter, we're forced to cut the clothes off patients who arrive in the trauma bay. For many of our patients in the Big City, the sweaters we slice through are their only piece of warm clothing.

I know that there are many worthy causes competing for your attention, especially at this time of year. But as you're looking through your closets, if you happen to come across winter clothing that you no longer use, please consider donating it to your local emergency room. It's a simple way to have big impact, especially for many of the homeless men and women living in our communities.

And while you're filled with the holiday spirit, please consider saving a life by donating blood!

Tuesday, December 1, 2009

Alley-oop!

In the ER, you must always be on your toes. You never know when, say, a patient might decide to hurl himself over the rail of a stretcher.

Fortunately for this particular patient, the tech and paramedic who had just transfered him off the ambulance gurney were still at the bedside. In a particularly impressive display of reflexes, both of them caught the patient in midair, lifted him back over the rail, and deposited him gently on the bed.

Both are being scouted by the Harlem Globetrotters.