I have talked in the past about why I choose to work in the less affluent neighborhoods. The hospitals aren't fancy and the patients don't have great, if any, insurance. There are no frills. But the cases are great. In affluent areas, the patients generally are not as sick. So the ER isn't used to the good stuff, the nurses are less experienced with sick patients, and it's just not as fun. So yes it's a little less money in the hood but too much fun to pass up.
My group has a mix of hospital settings, from fancy to flat out ghetto. I usually split my time with the ghetto hospital in the hood to the poor-to-middle-class hospital in the nicer hood. Tons of sick patients. Today....I got to do stuff some ER docs never see.
1-Pericardiocentesis: Post dialysis CPR in a 45 year old male. Regular code meds (epi, atropine) were not working. I put the ultrasound probe to his heart and there was a huge tamponade (blood in his pericardium constricting his heart from beating). So I grabbed the 18 gauge spinal needle and 20cc syringe, and stabbed him in the heart with it! I have been waiting to do that for a long time. I withdrew about 20 cc's of blood, and wallah there's your heart beat!
2- Thoracotomy (Cracked Chest): Not a procedure I would generally do. The survival rate is less than 1% and it really isn't advocated anymore.
A 25 year male was coming in CPR after a gunshot wound to the chest. If I was alone, I would not have cracked his chest. But....the other doc on (my boss and hero) is a trauma guru and loves to crack chests, so I figured I might as well take advantage of the situation and do the procedure with a pro.
Within 2 minutes of the patient's arrival, I had cut down and spread the ribs apart, grabbed the heart, opened the pericardial sac, and started repairing the big ass hole in his right ventricle. It was freaking awesome. As soon as I had that hole put together, he got a strong heart beat back. He did not end up making it, but hopefully the experience will save someone else in the future.
-ER Doc
(not an image from my case but a google image)
6 comments:
That sounds like a tough time! But yeah, if the challenge is worth it... go for it!
I think there is NOTHING like first hand experience. The cracked chest may not come along again for 10 years but you will never forget what that patient taught you.
Wow! I am constantly amazed that people actually can perform these amazing [gross :)] life saving procedures. You get excited about it and I am just fearful and a little bit in awe of it all but I'm glad there are people out there doing it.
After reading your blog allll weekend long, I have figured out (I think) which hospital your in. Been there
Once for trauma about 9 years ago, dragged by a car....wouldn't touch that er now unless it was trauma, but
I can see where you get your stories!
Wow. That was quite the day. You mean it's not like Grey's Anatomy where periocardiocentisis is a bi-weekly occurrence? Snerk.
Cool shit. That is why I trained in the hood myself. I cracked several chests, did a pericardiocentesis, and two crichs. Haven't done any since in my surburban non-trauma hood but at least I had the experience. My colleagues who trained in non-hood programs have never done any of these things.
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