If I Had A Nickel

Now, never having tried illy myself, I cannot speak from personal experience about its effects.  But repeated encounters with formaldehyde-laced marijuana aficionados have left me to wonder if it's the drug itself that causes people to run down the street naked, or if people who like to run down the street naked simply use illy more often than the general population.  In either case, a nickel for every crazed, would-be Roger Bannister who ended up in the ER would make me a very rich man indeed.

That's The Way I Like It

"Big City ED, be advised that our patient has entered cardiac arrest and we are coding him en route."  So much for the abdominal pain that they had previously radioed about.

As I moved to the trauma bay to throw a body bag over the stretcher, I thought that if there was ever a good time to code, it would be a witnessed arrest in the back of a ALS ambulance only minutes away a major trauma center.  Unlike the majority of coding patients who arrive already dead or close to it, this guy had a fighting chance, and we knew it.

The triage nurse had the ambulance bay doors open and the attending stood outside, waiting.  I primed some fluids, resuscitation meds were drawn up, Respiratory was paged and the defibrillator stood charged and ready.

As the ambulance peeled in with sirens wailing, the rear doors opened to reveal a second attempt at intubation underway.  Unable to get the tube, the medics ran the stretcher to the trauma bay while doing one-handed compressions.  

Clothes were cut, leads placed, a second line started and the airway secured.  Nurses pushed rounds of meds while techs cycled through compressions and the attending calmly called out orders.  After the third defib, the patient regained his pulse.  An ICU team arrived with a cooling unit to induce hypothermia, and not more than 20 minutes after arrival the patient was on his way upstairs.

Talk about a rush.  Job well done, all.

Now Here's a New One

Looking for a more convenient way to schedule your trips to the ER?  For those whose perception of an emergency varies with the wait time, one Albany hospital is offering a service that allows potential patients to text message the ER to see how long they'll wait.  What's next, offering appointments? 

Stroke Blues

Took care of two patients recently who had suffered strokes in the past and were living with significant deficits.  One gentleman, who I recognized from a few previous trips over the years, could communicate fairly effectively but slurred his words, making them difficult to understand.  I could see the frustration in his eyes as a group of us gathered around him struggled to comprehend what he was saying.  I hate that feeling of impotence that comes with dealing with stroke patients who have clear wishes that I am unable to understand or help them with.

The second patient was an older lady who experience a much more severe stroke that left her unable to communicate or move her left side.  There was little I could do to make her more comfortable beyond propping her up with some pillows and stopping by every so often to wipe off the drool that had spilled down her neck.

No real moral of the story here, just the frustration of dealing with patients that I can't help.  And a reminder to learn and recognize the warning symptoms of a stroke.  Calling 911 immediately and arriving at the hospital within 3 hours of symptom onset can make you eligible for tPA, a powerful clot-busting drug that may reduce long-term disability for some stroke patients.  If you or a loved one start experiencing stroke symptoms, never wait to call 911!

Spoiler Alert

Turns out that the EKG, cardiac enzymes, and chest xray were all normal on the patient presenting with chest pain two days after breast enhancement surgery.  

Memorial Day

If you're lucky enough to be spending the holiday enjoying warm weather and BBQs with friends and family, I hope we all also take the time to remember the sacrifices of the brave men and women who have given their lives in service to this country.  To all the members of our armed forces - past, present, and future - thank you.

Just What I Needed

Walked into a patient's room last night to help start the workup, and she immediately opened with "Doctor, I'd like you to meet my son."  After explaining that I was the tech, and still many years of education and many more loans away from an MD, I proceeded to hook her up to the monitor, run an EKG, and draw a set of cultures.

An hour or so later, as I was getting her packaged to go upstairs, she grabbed my hand, smiled, and said, "Don't worry honey, you're going to make it."  After struggling a bit lately over the whole med school application process, it was a perfectly-timed and gratuitously nice thing to say.  It's amazing how a few kind words can put you in a good mood for the rest of the night.