On the Warm Side of the Color Spectrum

As predicted, we were busier in the E.D. today. At one point we had about 12 patients in the waiting area, and all 20 rooms full. We managed to clean out the waiting area, but then as I was leaving, it started filling up again. And that didn't include the traumas. Traumas take priority, and they go straight to the code room regardless. So you might be busy seeing patients and then have to drop everything to see the trauma.

I think at one point I might have mentioned the triage system which assigns a priority to patients based on how sick they are. In general, the color codes are:
Red - see immediately
Orange - see within 10 minutes
Yellow - see within 15 - 30 minutes
Green - see within 30 - 60 minutes
Blue - see within an hour or two

If you know anything about colors and the color spectrum, you know that blues and greens are cool colors and oranges and reds are warm colors. As an intern, you generally see blues and greens. As you get more comfortable, you venture into the yellow and might actually get to see an orange.

Now, as an unofficial second year, my colors are generally yellows, some oranges, and occasional reds. I do get the occasional green or blue depending on how busy we are, but today especially my attendings physically started handing me orange charts to evaluate, and I was directed into the trauma code room, actually paged once to the code room, where the color is always red.

Also, it makes working more interesting. I don't see as many of the garden variety patients that come into the E.D. I see the sicker kids with more extensive and chronic illnesses. Amoungst my patients tonight I saw a sickle cell patient with chest pain (orange), a cystic fibrosis patient with an exacerbation (orange), vomiting in a 5 day old (yellow), and three traumas (all reds).

The traumas were:
- a 2 year old that fell 15 feet down an embankment and ended up on a concrete landing, to CT and admitted
- a 10 year old who fell off of his bike, onto the street, where a car ran over him, he got discharged with a skin burn on his leg from where the tire scraped his skin
- a year old baby that was sitting on her sister's lap when she fell over backward off of a porch swing, a CT scan showed a head bleed, and as I was leaving they were going to the CT scanner with neurosurgery, she will for sure be admitted to the Pediatric ICU as she was intubated (had a breathing tube in) and seemed to be having seizure-like activity, I'll find out how she did tomorrow

As for the patient with the axillary artery laceration, they ended up being transfused 6 units of blood. Given that the average adult has about 5 - 6 units of blood circulating, they had to replace the patient's entire blood volume and then some. He's still in critical condition in the Peds ICU.

That's it for tonight. Back to the warmth tomorrow.