Sunday, September 21, 2008

super power

Tertiary syphillis...

it can morph a 125lb lady into the Hulk

Friday, September 12, 2008

It's not ironic

Chief Complaint:
Shortness of breath

"I feel like it's hard for me to catch my breath."

No kidding. If I had 460 pounds of flesh smothering my 1.4 pound lung, I'd be short of breath too.

Wednesday, September 10, 2008

Gun Control

Note to gun owners:

When cleaning/loading/checking your firearm, never point the firing end of the gun towards anything you don't mind being blown to bits.

Meet Mr. Brilliant, now missing a few "vital" organs. If only he'd known..


Several hundred compressions,
4 rounds of epi,
3 round of atropine,
4 runs of V-fib,
5 shocks.
Normal Sinus Rhythm.
"Where's his Rolex?"


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Tuesday, December 04, 2007

Twice in one night

Gang wars happen often enough, and I've seen plenty of their victims, but lately these gang members, or "Family" members seem to be getting younger and younger. The other night a crew brought in one such kid, a 14 year old, whose chest made a nice home for the blade of a knife. He was scared, his face didn't lie. Mom was holding his hand as the cot turned the corner into trauma one, but shortly her grasp was broken as we began to work on her son. The 3rd year trauma resident working that night took one good look at the stab wound:
it was right chest, midclavicular, just about 3rd intercostal; he then pushed his gloved index finger into the wound and it came back bloody up to the second joint. "Chest tube set up on this side please." He hadn't even listened to breath sounds, but just by watching this kid's work of breathing and seeing that stab wound, he knew a thoracostomy was the path of action to take.

Not only was this kid stabbed on the streets, but now he's hearing the doctor tell him that he has to stab him again with about a half inch wide tube that will go into his side because his pleural cavity is filling up with blood and his lung can't expand as it should. There's a paramedic student, wide eyed, and ready to help, I tell her to stand at the head of the bed and hold this kids little arm above his head so his chest is an open canvas for the doc. And literally, it is a canvas: the rust orange betadine is the paint, swirled around in bigger and bigger cricles until the entire right side of the chest is prepped.

This kid is tachypneic and he is so diaphoretic it's as if the ambulance stopped by at the local pool on the way here. I can hear the doctor giving pointers to the med student as he begins the procedure, "You wanna find the intercostal space between about ribs 5 and 6, midaxillary," he's feeling this kids ribs, there's the spot, "then grab a #10 and make about a 3cm or so cut like that," As he says this he takes the green scalpel and slices, the light brown skin separates, revealing the red flesh beneath. "Then, use one of these curved hemostats.." He riffles through the plethora of tools there on the tray and mumbles a few words under his breath, then, upon locating his tool, he jabs it into the incision, "You gotta shove it through this muscle right here," a grimace on his face, using a little of his own muscle, he's twisting the hemostat, employing his whole arm, elbow up, then down, as if he's changing the lugnuts of a tire. Then he reaches for the 32 French tube, and using the hemostat now clamped to the end of the tube, he advances the giant staw into the pleural cavity. Usually the tube fogs once it's in place, that's how you know you're in, but this time the fog was hidden by the rush of blood that flooded the tube; he had a hemopneumo. "Now you just have to sew it in place, where's the 0-silk?" After a few adept sutures and dressing, this kid is good to go.

He's breathing easier now. "Let's have xray shoot a chest before we go to the scanner." After the thoracostomy was successfully done, and only about 200cc of blood out in the Pleur-Evac, this kid went upstairs and is recovering as I write this. Pretty soon he'll be back out on the streets, worrying his mother, playing with knives. He'll live another day, probably several, and wishful thinking hopes that he will change his ways and start feeding the poor. I just hope I don't see him again flat on his back, arm above his head.

Thursday, November 15, 2007


Why is it that ER goers these days have such an infatuation with illness and disease? I should count the number of people that present to the ED with complaints such as, "I've had a really bad cough for 6 years, but yesterday when I coughed, my elbow hurt. Am I dying?" When myriad of diagnostics are done, and all tests come back "within normal limits", the doctor returns to the room with seemingly great news, "So it looks like you're going to be ok!" One could be easily amazed by the crestfallen faces and dissappointed voices when patients reply, "So I'm not going to die?" Then they'll add some other, "Oh I forgot to tell you..." complaint, all done in futile hope of adding severity to their case. People just want to be told bad news! They want doctors to tell them they have some terrible disease, or an illness that in 3 months will cause them to expire. Why is it that people desire to hear bad news?

And this isn't just my opinion - News casts cater to that human desire on an hourly basis. The news is loaded with woe and the shame of the human race: stories about grandpas raping grandchildren, and gangsters slaying neighbors, and how this one poor lady got a rare african disease from eating canned peas. The majority of it is bad news. Yes, they have the birthday parade, and bits on celebs donating money to give poor children toys (that give kids lead poisoning), but the news about the news is that people want to hear bad news.

I wish I could be in the room to witness the horrific look of shock on the face of a patient when a doctor comes back, clipboard in hand, and says, "Sally, your stubbed toe has triggered prolific organ failure throughout your body. You should begin making arrangements now." Now Sally, is that really what you want to hear? Just say, "Thanks Doc for making sure I'm ok! Boy, am I relieved!"

*Disclaimer* This is a vast generalization, and does not in any way claim 100% infaliability. This simply stems from working a long night on little sleep and common observations. Every example above is from my head and as fictitious as Charles Dickens.

Saturday, September 29, 2007

Person vs patient

Sometimes in the mad rush of blood, bodies, and body breakdowns, it can be lost, the fact, that is, that these people are just that. They're people. They have lives, or at least they did. They are real people, not just a mvc vs tree. Behind their fractured bones, ruptured organs, and bloody faces, they have normal lives. Their incoming call list: mom, home, dad, Aunt Tina; they have people who care about them, people who are there to recieve the 2am call, and actually care. They have little people who call them daddy, or mama, and make a running jump into their arms. They have bills due, time clocks to be swiped, yards to be cut. But here they are, lives in a gamble; dice being rolled, which way will they land? And you must know, that all is being done to keep this person on one of our beds, and not the coroner's. This could be your dad, or your sister. That possibility alone offers that extra incentive, the little push to work quickly, and with compassion, and speak to the family with more feeling. Just the other night a young kid, having some fun on a late night highway with a group of friends and their super bikes, took a nasty, unforgiving spill that landed him in a plastic bag. He'll never walk through the door, little ones running up to him, never be called daddy. But on the bright side, most of the 150-something a night will go home to all of those things; they'll be back to see us again. They're all people. Granted, they are people with diverse aches and complaints, but they're people nonetheless, and taking care of them is what we do.

Thursday, September 06, 2007

Love you Honey, crash.

There are myriad of ways to show someone that you love them: Shakespeare wrote about it, Hallmark profits from it, and as February 14th approaches, millions of men seek out ways to show it. Well the other night at the hospital, another of these ways was shown. It was that time of night, about drunk-thirty, people were leaving bars and calling sirened taxis to take them to the hospital. One such person came in the door, blood pressure in the 80's palp with several lacs to the head pumping out blood with every heartbeat; criteria for a level one trauma. As we do the patient juggle from EMS cot to hospital bed, one of the medics gives us the story: "Late 20's male found status post auto-ped, several lacerations to the scalp with large hematoma to the left parietal. Approximately 500cc blood loss on scene, pressure dressings applied, en route vital signs systolic BP 80 by palpation only, heart rate tach-ing in the 120's." This guy also had a pretty good sized chunk from his nose to his lip missing, which was also bleeding but not nearly as bad as his head, and surprisingly, he was able to manage his own airway. But that head, it just kept soaking through the thick dressings we put on it. Dr. G had come down with the trauma team, and before all the monitor leads were connected, he was at the head of the bed irrigating the lacerations and yelling for sutures. Those lacerations had to be closed. Since they were arterial, they weren't going to clot, and would just keep bleeding until there was nothing left to bleed. "I need 2.0 Vicryl" Handed him 2.0 Vicryl. Suturing ensues. "Now get me 2.0 cutting." That's the fastest suturing I've ever seen! He tied off the bleeders first, then a rapid rhythm of in-and-across, and out, and tie, until, "Throw me some more. No, not SH, just the regular." More suturing. It took this really fast surgeon 45 minutes to suture this guy's head so the bleeding would stop. Now theres some serious lacerations. Finally we were able to head out to the CT scanner. We had just left the trauma bay when a lady, handcuffed hands behind her back, a mess of tussled hair glued to her face by tears, and blood splatters on her pale blue shirt, jumped up from her seat and yelled dramatically, "Johnny! I love you!". We thought she was just drunk (found out she was there for a DUI), and kept onward. Only after we did the patient juggle in ICU and were back in the ER did we find out the rest of the story: That girl wasn't just a drunk-she was a drunk who was driving the auto that hit the ped in the auto-ped! And better yet, she turned out to be the girlfriend of our Mr. Head Lac guy. So, Shakespeare, you've got one to add to your list: Running over your significant other with a car is yet another way to show your love. Make a card for that, Hallmark. ;)