Watch that first step....

I am too tired to do my usual diatribe about the events of the ED. Suffice it to say that the majority of the reports from the EMT's this evening started with the phrase: "Patient went out drinking tonight and then..."
- the patient drove into a tree and crashed headfirst through their front windshield. After all the work-up was complete, the patient was found to have only sustained a bloody nose (refer back to one of my previous posts for rule #1 for drinking and driving: drink enough and you won't get hurt)
- "several unknown assailants" (Two Dudes must be on vacation... again, refer to earlier posts) jumped on several of our patients causing a variety of injuries normally seen on boxers who are on the losing end of the prize match
- the patient got into an altercation at a wedding leading to them being stabbed in the stomach, "really, it's just a flesh wound" lead to an exploration, and when 6 inches of the probe disappeared into the belly tissue, the patient was sent for emergency surgery
- the patients went out and rode their motorcycles which they subsequently crashed requiring the services of our Mercy Flight helicopters, the orthopedic surgeons, the neurosurgeons, and admittance into the trauma ICUand, our favorite of the evening, of which, believe it or not we had two:
- the patient got into an altercation at a local bar, went outside to avoid a further dispute, and tripped off the curb...

what I want you to realize is that this person is lying FLAT on the bed... the two spots you see on the skin just below his pant's line would be just above the front of the ankle if the foot was in the normal position. And, like I said, we had TWO of these injuries tonight.

... that first step is a doozy!

Tags: alcohol intoxication, dislocated foot, assault, trauma

The Red Bag Sign...

So, last night was drug and alcohol night, and the majority of the patients followed the adage of the Coneheads and "consumed mass quantities."  I was told that most of the local bars run specials on Thursday night and that the local college crowd gets a little rowdy. 

I was also introduced to a new medical diagnostic clue:  the Red Bag sign.  That's when a patient is so drunk or high they're vomiting, so the EMS guys tie a red bag around their neck like a bib so the patient can vomit right into it and not mess up the nice clean ambulance.  You pretty much know the diagnosis and the management as the patient is being wheeled in the door; red bag flopping, or sloshing, just a little as the case may be.



So, while one half of our patients were partying it up and getting rowdy (crashing cars, breaking windows, falling down stairs, knocking on neighbors doors and demanding to be let in to the point of being arrested and brought in by Buffalo PD, etc.) the other half of our patients were depressed and suicidal leading to a mixed bag of drug and alcohol combinations that were each a case study on how to treat overdoses.  Some were just drug A.  Some were drug A + alcohol.  Some were drug A + B.  And several were drugs A - F swallowed down with a good slug of vodka, or beer.  Of course, if you're going to really try to make a statement, you might just be a murder suspect being chased by police through the woods and decide to stab yourself several times in the neck with a hunting knife.  That'll show 'em.

And, speaking of cutting, I did have an 18 year old with cutting scars on her feet:  one of which read, "I love you to DEATH"  Seriously.  Cut into the top of her feet.  When I first went in to examine her, I thought she'd had some sort of accident.  Then I noticed the scar lines seemed to be making some kind of pattern, which I soon understood to be words.  Then I actually got to the point I could read the words.  This on a girl who didn't want any blood work done because needles scared her.  Uh, honey, you let someone CARVE into your skin with something most likely bigger and sharper than a needle.  Hmmm...

As of the time I left, all of the overdose patients were still alive (some despite repeated attempts at offing themselves with drug cocktails), the drunks were detoxing (we usually just let them sleep it off, sometimes needing four point restraints for those that refuse to go to sleep peacefully), the crack and cocaine abusers who were developing paranoid delusions as the night went on were being sent to the psych side, and the drunken 18 year old was being picked up to be taken home by her parents with a stern warning by one of the other ED docs about the dangers of alcohol.

Red Bag Thursday night.  The other must-see event.

Oh yeah, by the way, if you once burned the back of your throat while smoking crack cocaine to the extent that you needed to have a hole cut in your neck so that you could breathe, when you come back in complaining of a sore throat after you, uh, yes, wait for it, smoked crack cocaine again, we're gonna laugh at you.  Really.  Laugh and point.  Mhmm.  

Tags: overdose, ED, alcohol

First Shift, Late Night

Winston Churchill, the Social One, first greeter at the door.

So, I just got home, this morning, from my first "official shift" at ECMC.  I am scheduled for 4 days of nights, and if you've ever worked the night shift, you know the first day is a beast.  Your body is all out of sync.  You're tired, sleepy and grumpy even if you did manage to get a nap in the day before.  I loaded up on caffeine and sugar, courtesy of a Dunkin Donuts Vanilla Coolata which I picked up on my way in.  The buzz kept me going until around 3 in the morning when I finally hit the wall.  Then the barrage of patients kept me going until the end of shift at 7 this morning.

Just some thoughts on last night...

If you're going to start smoking... 7 is a good age to start.  Just start sneakin' em on the back porch of your grannies house with your school mates.  Keep up the habit until you're, oh say, 67.  Add "a couple of 40's" daily to that around your mid 50's and don't see a doctor despite knowing you have high blood pressure.  Come into the E.D. just about the time your blood pressure is 208/100 (btw: normal standard is about 120/60), and you're having problems standing up.  That should be just about right.

The old adage carries true even in Buffalo:  if a young male comes in beaten up, "Two Dudes" did it.  "Just mindin' my own bizness, doc, and these Two Dudes jumped outta their truck and beat on me."  There's a roving pair of hoodlums running rampant in every city in this country.  They're just Two Dudes looking to make some mischief.

If you're going to drink and drive, drink A LOT and you won't get hurt.  Drive that blood alcohol level to 0.446.  That's right, really high.  The legal drinking limit is 0.08 in most states.  For most people, 0.400 has them comatose.  Of course, you also have to remember to not wear your seatbelt and deactivate your airbags.  That way, when you ram head-on into that telephone pole and break the windshield, your body will be just loose enough to not sustain any injuries.  Well, ok, maybe a little injury like a slightly herniated disc in your neck.  No major structures around there anyway.  Nah, no problem.

When you're in the ED and you're asked if you have any medical conditions that might affect your care, say oh, if you're about to be zapped by a gazillion rads of energy from the CT scanner, please say you're pregnant.  That might affect how we manage your care.  Yeah.  That's right.  Just a little thing to remember.

When you're being sedated before a painful procedure, like setting a broken wrist, think of something pleasant and you'll remember that when you wake up.  I told my 15 year old male patient to think of somewhere fun and warm, when he woke up he told me he dreamt of candy and his bed at home.  Happy thoughts!

And, finally... didn't I mention I hate gyn exams... 'nuff said.

Tags: night shift, ED, alcohol, gyn exams, smoking, strokes