One More Trip to Go

Hope the song isn't foreshadowing tonight's events.  It's my last shift at the rural hospital where I've been rotating for the past month.  I have been so tired lately that I haven't blogged, and it's like any discipline, you have to do it consistently or else you get lazier and lazier... so I am making myself write today so I can get back on track.

Here's the video from Wednesday morning after I arrived at the hospital parking lot here in Downtown Buffalo.

My car is stopped and you can see some vibration from the wind.  Winds were blowing 30 - 40 mph with gusts recorded to the 70's and 80's.

One of my colleagues and I actually had to link arms leaving the hospital to get back to our cars after our meetings because the wind was so strong.  Driving home, there was a semi flipped over on one of the off-ramps, and I hit near white-out conditions at my off-ramp.

Driving to work that night wasn't too bad.  It was very windy and I couldn't use my cruise control like I usually do because of the gusts.  I had to keep adjusting my speed.  We had a total of 5 patients that night.  One with a newly-found brain tumor.  They got shipped to the Stroke Center, MF Gates in Buffalo. 

The other interesting one was having a heart attack as he walked in the door clutching his chest.  He received thrombolytics (clot busters) to help break up the clot.  It was amazing to see him go from severe to mild to minimal pain all within 30 minutes.  By the time he was packed in ambulance to be shipped out to the receiving cardiac center his EKG had gone back to normal.

Last night I was running late, mostly because I was so tired I overslept and then took a nap and then just lost track of time.  Some thoughts on the patients:

 - when you fall, try to think "tuck and roll" to protect your hands and wrists, that would have helped one of my patients who wound up with no broken bones, just a wrist strain.  The other who just fell sideways ended up with 2 broken ribs.  Nothing to do for those except pain control and to encourage deep breathing as there's a high likelihood of developing pneumonia.

 - some kids just get fevers and we don't ever know why.  However, if you bring them to the E.D. they're going to get poked and stuck in innumerable ways because we have to think about potentially fatal complications.  This little pedi (pediatric patient) did just fine and didn't look that sick.  They'll be seeing their pediatrician today, so we know they have good follow-up.

 - and then I had 2 cases of pancreatitis:  one was a chronic pancreatitis patient who came in vomiting, nauseous and looking for pain meds, and who really did have pancreatitis (lipase, a marker, was about 3700, normal is < 100) even though as ED personnel we get skeptical given all the pain med seekers we see.  The second came in with what sounded like some reflux/heartburn pain.  We do routine "belly labs" meaning looking at liver, kidneys and pancreas function and their lipase was close to a thousand.  We quickly scanned the gallbladder which is a common cause and didn't see any obvious stones.  They were admitted and will have a definitive study in the morning.

That's it.  My last shift is tonight, and Iam hoping for a good Friday night.  I have the rest of the weekend off and I want to start it on a good note.

Tags: pancreatitis, gallstone pancreatitis, alcoholism, FUO - fever of unknown origin