From One Extreme to the Other

Sometimes, you just gotta love the comparisons.  Case in point:

Spent my first four hours the other night working in the purgatory that is Fast Track.  I go out to the waiting room to bring back a patient whose cc is "throat pain since the AM."  Great, throat swab, drink some fluids, get some rest, thanks for playing.  Simple dispo, right?  Unfortunately, this train wreck devolved into, "Oh, I also have this rash" and "I get headaches sometimes." Also, intense ankle pain (despite walking back to Fast Track and no signs of trauma).  To top it all off, the next patient I brought back had the same last name.  Turned out it was Mom, who also had some sniffles.  And who stole the Kleenex box when she left.

Thankfully, I was able to move out to trauma for the rest of the night.  Instead of the common cold, we got a mugging gone bad, where the unfortunate victim had struggled for the gun with his assailant and ended up being shot in the neck.  It could have been much worse - the bullet only grazed him - but he was also apparently pistol whipped several times in the head and had a small stab wound to the arm.  After dealing with people who game the system, it's nice to be able to actually help a patient who truly needs emergency care.

Pleasant Valley Sunday

Nothing beats a long run on a beautiful warm Sunday afternoon (except maybe antidepressants, but I'll let Nurse K and Happy Hospitalist fight that one out).  

With Levophed On the Side

While enjoying homemade turkey lasagna with some non-medical friends last night, one of them pointed out how turkey always left them tired after Thanksgiving.  "Yeah, it's that chemical...dobutamine I think," another explained.  

Now if we had dobutamine in every one of our turkey sandwiches in the ER, we'd probably have a lot more tachycardic patients in our midst.  If we had to choose a drug to lace our box lunches with, I'd start with a healthy serving of Ativan sauce before anything else.  Nerd that I am, I suggested that my friends might be thinking of tryptophan instead.

Nein!

I'm starting to think they just don't make 'em like they used to.  

I recently took care of an elderly German man who had the misfortune of falling while trying to board the bus.  He arrived via EMS with questionable LOC, large hematoma on the forehead, and a dislocated finger.  After a great deal of protest, he was eventually persuaded to accept some pain medication before the reduction, but vehemently refused a head CT.  ("Nein, zee problem is vit my finger!")

Despite the best effort of the resident and attending, he continued to refuse the scan.  Worried that he may be altered from the head injury, the docs insisted that he stay for several hours of observation instead.  Not happy, every few minutes he would pack up his lunch box, gather his newspapers, place his hat firmly on his head, and begin a slow march to the exit.  And every few minutes I would chase him down and ask him to return to his room.  After a few thwarted escape attempts, he grabbed my ID, wagged his finger at me, and stated: "I'm going to call zee newspapers and tell them that you, Second Shift, keep old people here against their will!"  I explained to him for the umpteenth time why we were concerned, and escorted him back to the stretcher.

At one point, the resident began to get fed up and told me to place him in restraints.  I turned her, and explained that if she wanted to shackle a stubborn 75 year old man to the bed, she was more than welcome to try, but there was no way on earth that I would do it for her.  My worthy adversary and I continued to spar for a couple more hours until his son arrived and finally took him home.

I'm keeping an eye out for my name in the papers.

In the Eye of the Beholder

In general, I have a very low tolerance for status dramaticus.  If a patient is brought in to the ER screaming and writhing in pain, and doesn't have a damn good story to back it up, we tend to assume BS.  Such was the case for my gentleman the other night, who arrived clutching his chest, rocking back and forth in the stretcher, all while pleading "Don't let me die!"  Normal EKG, negative cardiac enzymes, pain completely resolved with one GI cocktail.  Maybe if he had taken off the designer sunglasses at any point during his stay, the act would have been more convincing.

The same advice applied to the drunk vs. stairs that rolled in later that evening.  Sporting a broken pair of shades that were missing a lens, he emphatically informed me that there was no need to check his blood pressure, as he could feel that it was "seventy over one and a half."  Taking the patient at his word, I charted the BP and moved on.

The End

In the flood of valedictory articles that have appeared online over the past week to commemorate ER's final episode (airing tonight on NBC), several have commented on the many contributions the show has made over its 15 years.  The popularization of the steadicam and fast-paced medical jargon in TV dramas, an increased interest in emergency medicine residencies, and greater awareness of medical issues presented on the show have all been listed.

According to this article from the LA Times health blog, however, ER's lasting legacy might be screwing up a generation of medical education.  The article discusses a Canadian study that found medical dramas were the second most cited source of training for intubation skills, and that ER does it all wrong.  

As I watch ER for its entertainment and not its didactic value, I plan on enjoying tonight's finale.  Besides, I get more than enough evidence-based, real-world education from House.

A Day in the Life

Typical busy night last night - we were short staffed, the lab was backed up, and the waiting room was full of patients who had been there since morning.  It certainly didn't help that Nearby Hospital had lost power and we were receiving all their diversions.  Working in the critical care area, I was juggling three ICU patients and one little old lady who kept asking for a cup of water every five minutes.

Still, things didn't get bad until the strong winds outside blew the helicopter off the roof.  It made a crash landing in the middle of our ambulance bay, but we were thankfully able to get everyone out moments before it exploded in a massive fireball.  The patient they were transporting, however, was having a massive MI and required ten rounds of defibrillation and an open thoracotomy before we could stabilize him for the cath lab.

Later in the evening, I stepped outside for a moment to grab some fresh air, and was nearly run over by a car swerving into the ambulance bay.  Redirecting them around the still-burning hulk of the helicopter, I opened the rear door to find a woman in active labor.  With the baby crowning and no time to call for help, I was forced to deliver in the parking lot.  While tying off the umbilical cord with my shoe string, the mother suddenly lost her airway.  Lucky I still had my pen on me, as I used it to perform an emergency cricothyrotomy.

After getting Mom and Baby safely brought up to OB, I returned just in time to hear EMS patch from the scene of a crash involving a busload of hemophiliacs.  While prepping the trauma bay, I noticed we were out of medium gloves, and headed to the supply room to grab a fresh box.  Hot Doctor and Sexy Nurse were in there going at it again, forcing me to slide around them to reach the far shelf.  Once all the trauma patients were transfused and safely up to the ICU, I was finally able to grab my thirsty old lady her water and called it a night.