Train Wrecks

When the sun goes down and the EtOHers start rolling in, the name of the game is getting them cleared to the drunk tank as quickly as possible. Last night, however, it seemed that each and every one of my patients was ready to start circling the drain.

Train Wreck #1 was a middle-aged EtOH all star who presented for nothing more than being found drunk on the street. He had a bit of a medical history, however, so the PA asked me to draw some basic labs. Turns out, in addition to being hammered, the patient also had positive troponin, low potassium, an elevated white count, uncontrolled diabetes, and renal failure. And a broken hand.

Train Wreck #2 also had a splash of EtOH on board, but would suddenly go from happily singing to dropping his head into his box lunch and going unresponsive. Another poorly controlled diabetic, his sugar would careen wildly from 180s following an amp of D50 down to 40 if he stopped sipping his orange juice.

Train Wreck #3 made his third EtOH-related visit in a 48 hour period at the beginning of my shift, got discharged, and returned as a heroin overdose by the end of my night. For whatever reason, treating ODs makes me really sad. Despite this, my patience was frayed as my last hour devolved into a constant game of reinserting the nasal trumpet the patient kept pulling out, and providing repeated sternal rubs to stimulate his oxygen saturation back into the 90s.

Next time I complain about straight drunks, I'll need to remember that it could always be worse.