I saw a fair number of patients today. It was actually not as stressful as it's seemed the last two days. I think it has to do with the attendings and the patient load. Both "lightened up" a bit today giving us some breathing room for the patients we did have... and they were a very interesting mix indeed.
For a moment, I actually thought "Crash and Burn" would be a better title, but the two most memorable patients during this shift were of the, shall I say, larger portion of the population. And, experience shows that when they crash, they crash hard.
The first came in with a pulmonary embolism. She went from a "oh I'm having a little trouble breathing" to dropping her blood pressure, her pulse and needing to be rushed to the ICU. We later heard that she needed to have a breathing tube placed. An anticoagulant was started to help with the massive blood clot in her lungs and she started vomiting blood. We don't expect that she will do well. Luckily, in some ways, her entire family was always around and at her bedside.
The second came in having been found by a neighbor collapsed in his apartment. He was dirty and unkempt as he might have been down at least a day, maybe two. He didn't have any power in his apartment. We don't know why. He was minimally responsive when the EMT's brought him in the door. He was able to answer my questions after some oxygen and fluid. Then he crashed. It's hard to put a breathing tube in someone who is overweight. The angles are all wrong, and it's hard to see the breathing tube go in the right place. We have a new fiber optic scope that makes things easier, and the intubation seemed to go well, until he started vomiting blood all over, blocking the view and leading to a feeling of general badness. He started to drop his blood pressure, and we started ordering blood products. I don't know that he'll do well. He is alone. No family, no one to contact. Just a concerned neighbor without whom he probably would have died alone in his apartment.
I had a lot of headache patients today:
- assault - hit in head three times with a fist - CT scan neg.
- blunt force trauma - hit in head by falling window - CT scan neg.
- carbon monoxide poisoning - if you're in a house that smells like gas, don't wait two days before calling the gas company. Open the windows and get out. - get put on 100% oxygen for 3 hours
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