Friday, October 30, 2009
Thursday, October 29, 2009
It was thirty minutes before the end of my shift. I had almost tied everything up and was planning on leaving on time for once. Out of nowhere, paramedics burst through the doors of the ER with a very sick patient. The patient was a 400-plus pound intubated Mexican man. No one in the ER knew he was coming in. We always get an alert when an ambulance or helicopter are on their way to us. With this case there was no report, no one called ahead, NOTHING! As the paramedics came closer, I noticed something out of the norm. All of the paramedics were Hispanic, and the writing on their uniforms were in Spanish. "This can't be what I think it is," I thought.
So as we got him into our critical care room, we learned that he was in a Mexican hospital for the past week and his family was disgruntled with the care he was receiving there. The doctors tried to transfer him to us a couple of days prior, but our hospital refused (It's not a law that we have to accept transfers from other countries). So after being rejected, his family paid a large some of pesos to rent a jet to fly him to the states, and had a helicopter waiting once they landed to transfer him to our hospital. That explained why we didn't receive any advanced notice of the patient. It was an illegal transfer, and the chopper just landed on our roof!
Not only was the patient critically ill and on the ventilator, he was unstable. The only history we had was a patient summary from his hospital stay in Mexico...and it was hand written in Spanish. His oxygen saturation was low despite being on the vent, his blood pressure was low, and his heart rate was through the roof. He had medications hanging through an IV, but the IV wasn't working! It was a mess. Eventually we stabilized him, and he made it to the ICU.
What's going to happen to the Mexican hospital? Nothing. They don't abide by our country's hospital ethics laws. What's going to happen to the patient? I don't know, but I do know that we just inherited all the substantial medical costs to take care of this unfortunate gentleman... and I left my shift and hour and a half late :)
Tuesday, October 27, 2009
A couple of male patients kind of weirded me out today. Both married med in their 50s.
The first needed a prostate exam to rule out prostatitis. He said he never had this exam done. After the exam, he thanked me and said it was the most action he had gotten in awhile, and said he couldn't wait to tell his wife that he was right... putting something in there doesn't hurt that bad. I asked that he wait until he gets home to tell her that.
The second needed a foley to measure his post void residual volume. I have NEVER met a man who enjoys getting a foley....but there is always a first. He thanked the nurses over and over again, stating that it felt so great and that he hasn't "gotten any" in over a year. He laid back and relaxed and asked for a cigarette!
No wonder I found my self washing my hands more than normal today.
Saturday, October 24, 2009
A 65 year old female arrived via ambulance with a heart rate of 220 and feeling very dizzy and lightheaded. After a 12 lead ECG, it was determined that she had a rhythm called supraventricular tachycardia (an arrhythmia originated above the ventricles resulting in a very, very fast heart rate).
I proceeded to give her the standard treatment... a fast acting medicine called Adenosine. I gave her 6 mg IV push and the heart rhythm never changed. I then gave her 12mg IV push and saw the characteristic long pause on the ECG (looks likeasystole )...which is the medicine "resetting" the heart back to normal. After the long pause, however, the heart went back to 220 beats a minute. I debated shocking her, but decided to give her someAmiodarone b/c the second ECG looked more wide complex then the first. After I gave her 150mg Amiodoarone her heart rate slowed down to the 160s, but had yet to revert back into a normal heart rhythm.
I left the room to check on another patient when the nurse pushed the code button and started screaming for help. I immediately ran back into the room expecting to see my patient inasystole... but instead found the patient's husband passed out on the ground. Unknown to us at the time, the husband had a habit of passing out in medical situations. After tending to the husband, I looked back up towards the wife. To my delight the husbands vasovagal episode scared the patient so much it caused her vagus nerve to fire strongly... which reverted her back into normal sinus rhythm!!!! She had failed three different drugs, but in the end all it took was her husband to pass out.
I told her to bring her husband to the hospital the next time she goes into SVT.
Tuesday, October 20, 2009
A patient from a neighboring country had a vascular problem with her foot. The prognosis given to her foot was grave, and she wanted a second opinion. Someone from her family recomended our hospital (which again is in another country) as her saving grace. They packed up and got in the car and started to drive. For some odd reason, they put her foot in ice for the drive to "stop the infection from spreading." So they drove, and drove, and drove (passing many large cities and hospitals on the way) for about 20 hours to our hospital....all with the foot in ice. So needless to say when she arrived her foot was hypothermic, black, and dead.
Not much could be done at that point. I guess second opinions can be overrated.
Monday, October 19, 2009
Non-Clinical Clinical Prognostic Indicators
-Your doctor hasn’t seen you yet, and you’ve been waiting for (insert average wait time) hours.
-You’re in a bed in the hallway.
-Your complaint consists of “months” or “years” of pain/nausea/headache/X Y Z.
-You’ve come to the emergency department for a second opinion, despite multiple subspecialist evaluations.
-You answer yes to every symptom the doctor asks you about.
-You get a blood draw, but no IV.
-The only medication you’re given is tylenol.
-Your doctor says the words “probably” and “virus” in the same sentence.
-You are talking on your cellphone, playing a game, or chit-chatting.
-You are talking on your cellphone, playing a game, or chit-chatting and the doctor has to ask you to stop.
-You “just wanted to get it checked out.”
-Your primary care doctor sighs on the phone when the emergency physician calls him or her.
-You get not one, but two IVs.
-You remark, as my GI bleeder did last night, “Boy, I’ve never been to a hospital so attentive and efficient!”
-You get your own personal doctor to take you to the CT scanner.
-Multiple doctors, nurses, and staff greet you in your room.
-The triage nurse walks you to your room and points at you while speaking to the doctor.
-You get a room all to yourself.
-You get a monitor.
-Your monitor keeps beeping, even though you’re not doing anything.
-Your doctor keeps checking on you.
-Your doctor sticks a finger in your bottom.
-You don’t argue with the doctor about getting this treatment or that one.
-You are kind, good-natured, and have been a good person in this life.
I will seek and find you.. I shall take you to bed and have my way with you. I will make you ache, shake & sweat until you moan & groan.I will make you beg for mercy, beg for me to stop. I will exhaust you to the point that you will be relieved when I'm finished with you. And, when I am finished, you will be weak for days. All my love, The Flu
Friday, October 16, 2009
Wednesday, October 14, 2009
An 85 yo man and 84 yo female married couple arrived to the trauma bay after a head-on-collision in which the man entered the freeway going the wrong direction. Both of their injuries were critical. The man sustained a severe pelvic fracture, and his wife had a hemothorax (blood in the chest cavity). The wife was more critical than the husband, so we intubated her and placed a chest tube to drain the blood.
Shortly after placing the chest tube in the wife, she became bradycardic and lost a pulse. After about 30 minutes of resuscitation, she died. Afterwards, I went over to the husband to reassess him. He kept asking me "how's my wife?" I couldn't answer him. I proceeded to get the CT scans that he needed. He again kept asking everyone "How's my wife?" At that point, we debated not telling him until he got to the floor. He kept asking and then said "We have been married for 65 years." We told him....and it seemed he let go. He died later that afternoon, shortly after he was told that his wife passed away.
Friday, October 9, 2009
Saturday, October 3, 2009
A 45 yo strange looking female arrived to the ED with chief complaint of "bright red blood per rectum." I went into the room and asked her "What brought you in today?"
Thursday, October 1, 2009
As an ED physician, you often encounter certain patients that make you wonder what kind of person they were to touch your life so genuinly- even if briefly. I'm not sure why he stuck in my mind. Maybe it was that he reminded me of my grandfather. I wanted to know more about his career and what "the war injury entailed." More importantly, I wished he was still farming and alive to tell the rest of his WWII stories. In a way, I feel honored to have served him during his last days, just as he served his country and the world during WWII. He served a greater good and higher power then I can ever dream to serve- salute and cheers.