More Bad Press for UChicago

From page 3 of this morning's Wall Street Journal, an article about a plan by UCMC to reduce their number of ER beds that has led two physicians to resign in protest.  

"The current plans to cut our bed number further will make it more likely that only the poorest of the poor will be waiting prolonged hours for care, longer than will be safe," wrote one of the physicians.

The hospital also plans to close a general medicine unit and an ICU, placing further strain on the remaining ER beds and increasing patient boarding.

Yet another sign of the times.

A Tale of Two Gunshots

After receiving a call for shots fired, EMS responded to find a young male found lying in the street in a pool of blood.  Their early patch meant that the trauma team, ER docs, three nurses and two techs were waiting at the beside, the rapid infuser was primed, and X-ray and respiratory were standing by upon their arrival to the trauma bay.  Barely conscious, the patient was pale and had a last reported pressure in the 60s.  The mob descended on the guy before the medics had even transferred him to our stretcher, but it only took one quick look by the trauma attending to call everyone off and redline him upstairs.  I threw on a portable monitor while another tech held the elevator, and we rushed him up to the OR with a resident holding pressure on the leg.

Contrast that with the guy from last night: high out of his mind and status-post ass-kicking.  Several bruises and small lacs to the face drew everyone's attention while I cut off the guys jeans and discovered a through-and-through GSW to the thigh.  I tipped off the resident, who proceeded to ask the patient if he knew he had been shot.  The response: "Nah, dude, really?" 

No Flash Photography

Wisconsin nurses accused of taking photographs of an X-ray of a patient who presented to the ER with an object in his rectum and posting the image on the internet have been fired, and their case forwarded to the FBI to investigate HIPPA violations, according to this article linked from CNN.com.  A good opportunity to remind everyone of the disclaimer appearing at the bottom of the page.

Internal Dilemma

So on the one hand, my patient was probably taught to share at a young age.  Odds are he was also instructed to cover his mouth when coughing.  I understand his dilemma, struggling between two deeply-ingrained life lessons, but in the case of pneumonia, I'm really going to have to side with covering your mouth.  I'm sure a profound sense of generosity motivated him to cough directly into the face of anyone who came near him, but the rest of us are fine without pneumonia of our own.  In fact, I was so inspired by his example that I decided to share one of our masks, and tell him I'd call security if he took it off.

Which One is Not Like The Other?

Checked the board at the beginning of my shift last night to take stock of my patients:

CP, AP, SOB, AP+, restless legs, stroke, minor MVC.

(translations: chest pain, abdominal pain, shortness of breath, abd pain - pregnant).

Now restless leg syndrome is a legit condition, but seeing up on the board along surrounded by those other complaints definitely gave me a chuckle.  With four exams spaced out over the next week, I'm hoping that all the right answers stand out just as clearly.

Code Flu

It's called the common cold (google.com/flutrends).

After eight agonizing hours spent working in Fast Track and witnessing a nearly unbroken string of "upper respiratory tract infection" dispositions, I have decided that the Big City ED needs to implement a Code Flu protocol.

Upon presentation to the Emergency Department, patients between the ages of 18 and 65 must undergo rapid screening to assess whether symptoms (cough x 1, sneezing, fussiness >5/10, being sleepy, runny nose lasting longer than 2 minutes, general achiness, wanting to skip school/work) warrant activation of a Code Flu Protocol.  If any of the above criteria are met, the triage nurse, in consultation with the Charge Nurse, will instruct the secretary to overhead page Code Flu with a D2C (door to couch) goal of 5 minutes.

The Code Flu Protocol requires:

*Patients will be brought back to a comfy couch to be evaluated by an emergency physician.  

*Trauma Nurse will provide a heated blanket to the patient on the comfy couch.

*Respiratory will be paged for a stat portable humidifier.

*Pharmacy Tech will deliver a pre-mixed bag of IV chicken soup.

*ICU Code Team will rapidly respond with sterile tissues and high-dose antihistimine.

*Mom will be paged to take the patient's temperature and provide prn reassurance.

*Upon stabilization, and with approval of the attending physician, IT Services may modify the cardiac monitor to display daytime television.

I think it's going to be a roaring success.

When I'm Nintey-Four

I'd like to say that a patient experiencing "senile agitation" came after me with their cane like in the picture above, but that would be a lie.

He used his walker.

And while we certainly didn't break out the thorazine to calm him down, he did require some coaxing before relenting in his quest to trample me to death using his gray plastic mobility device with the hollowed-out tennis ball booties.  I've encountered a broad spectrum of elderly patients in my time in the ED, running the gamut from the senile to the serene, violent to vivacious, and more than one inappropriately flirtatious.  Although part of me fears that I'll grown into the potty-mouthed old codger who hurtles obscenities and used Kleenex at the ER staff with reckless abandon, I'd much rather become the crazy grandpa who can't stop laughing while telling dirty jokes.  I'll probably end up somewhere in between.

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