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.