Drama Time

So an 18 year old dad and his 16 year old baby mama bring in their 10 month old child to the ER. The waiting room was busy, and the mom sat down without saving a seat for the dad.

This infuriated big daddy. When they got to a room, he started yelling at her. Things got ugly. The nurse called security. Before you knew it, daddy was beating the living hell out of this poor, young, baby mama. Everyone tried to pull him off, but his fury of not having a seat saved for him prevailed. He grabbed the baby, threw him across the room, and continued to beat the mother.

Eventually enough cops were there to contain him. When the mom was let free, she grabbed mace from her pocket and tried to spray him as he was being put in handcuffs. She sprayed it everywhere, unfortunately, and the little baby ended up with mace all over his face.

This was worse than any Jerry Springer drama.

-ER Doc

Eye Opener

Our Emergency Department uses a lot of traveling nurses (nurses that take on temporary assignments around the country).

Last week a new one did not leave a good first impression. She showed up an hour late....8am...and DRUNK.

The nurse manager came down and tried to handle it very respectfully. He even offered to call her a cab. She threw a huge fit. Long story short....she ended up getting arrested for public intoxication.

-ER Doc

Take A Bite Out Of Crime

Next time someone is robbing you, try biting as defense mechanism. This poor robber's neck will probably need a skin graft. It was bigger than the picture portrays.



-ER Doc

Nursing Home CPR

The guidelines for CPR recently changed. There is a greater emphasis for "compression only CPR," meaning to not do mouth to mouth and just do chest compressions until EMS arrives.

A 71 year old nursing home resident collapsed to the ground. The esteemed nurses at the facility called 911 and started CPR...or so they think.

They had heard of the new guidelines, but they got things a little backwards. They thought it was "ventilation only" CPR, meaning they ventilated but did not do compressions.... meaning she had no circulatory volume.

She didn't make it, obviously.

-ER Doc

2-fer

Sometimes you pick up a chart and you see that you are getting to see more than one patient. Usually a parent will bring in both kids to be checked out, etc. The most I ever had was 14. This was from a shelter that literally dropped off a van of people who had been exposed to scabies.

Last week we had a mom and daughter combo. The mother was in for "std exposure." She found out her boyfriend had Chlamydia and Herpes, so she wanted to be checked out.

She brought her daughter, who was TWELVE YEARS OLD, with her so she could get Plan B. Plan B is the "abortion drug," meaning the twelve year old was already sexually active.

We referred mom to county health and daughter to the local pharmacy (you don't need a script for Plan B) and planned parenthood.

What a 2-fer. Like mother like daughter I guess.

-ER Doc

Follow Up

So in my previous posts one of the cases I talked about was an aortic dissection. I have done some fun stuff lately at work, but this case I am very proud about (and I really didn't do much).

Aortic dissection are not common. When you do find one, it is usually too late and the patient dies. This patient was relatively young (40s), and did not have the classic symptoms of a dissection. The only reason I looked for it was because he had a new murmur. I very easily could have not gotten the cat scan (almost didn't), and he would have died.

So when I found it, I was thinking this guy might actually survive this b/c we caught it early. When I called the thoracic surgeon at midnight, he did not share my enthusiasm. He was PISSED b/c he had a big day scheduled and did not want to be operating.

He even asked if I could transfer him to another hospital! Of course I said NO I am sure other hospitals thoracic surgeons have big days planned as well.

So after yelling at me for finding this dissecting aorta in a young man, he was forced to take him to the OR. He huffed and puffed and said what a waste of time this guy is going to die.

Guess what....less than a week later, the guy went home today. He WALKED OUT of the hospital and should be fine.

Great save indeed, despite grumpy f***ing surgeons.

-ER Doc

Wild Shift

The last month and a half have been surprisingly slow. Acuity had been down. I had been complaining the last two weeks about my lack of intubations, central lines, codes, etc.

Last night things finally blew up the way I was hoping for.

A 54 year old with a big head bleed that required IV anti-hypertensives and eventual intubation....

Then a healthy 42 year old male with chest pain. Good chest pain story for angina. He had murmur though, so I scanned him for an unlikely aortic dissection. Sure enough he had one, so it was time for an Esmolol drip and a cardiothoracic surgeon...

Then a good old case of respiratory failure that required intubation and a central line.

Then a seizing febrile 9-year-old little boy. After a full workup including lumbar puncture...it was apparent that the flu got the best of him.

As I was wrapping up the LP, the charge nurse grabbed me b/c a trauma CPR was 3 minutes out. A 29-year-old was shot in the chest with a 9mm by his wife. I did a thoracotomy (cracked open his chest to try and repair the hole in his heart and clamp his aorta), but he died. I was feeling great tho!

Then 35-year-old who kicked the shit out of a concrete wall. He fractured and dislocated his ankle, meaning I got to consciously sedate him and reduce the injury.

My last patient was not exciting. He was a homeless man who wanted me to trim all his toenails. Fastest discharge EVER!

-ER Doc

A Spider Bit My....Penis!

This was the real deal. A poor 46year old Hispanic male was bit in the penis by a black spider. He went to another hospital initially and was discharged. Below are his nurses notes (pretty humorous). Fyi.... Pt= patient and OSH = outside hospital.

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Note 1: "Spider bite" (states it was a black spider) to penis while sitting on a toilet. States immediately cut his penis with a knife to extract the "venom". Pt was seen at OSF and given hydrocodone for pain and reports thehospital staff thought he was bitten by a human, pt denies this. Pt now reporting pain in abdomen and chest and feels as if his "nerves are tight."
Note 2: Pt to ER for spider bite to penis at 0900 this morning while on the toilet. Pt reports he visualized the spider. Pt was seen at OSF but reports that they believe he is lying and gave him Lortab and tetanus shot. Pt reports he cut the area of his penis to drain it. Pt reports white fluid came out. Pt with small superficial cut noted to penis. No bleeding. Pt reports pain as squeezing of testicles that radiates all the way up to his chest. Pt reports this pain is constant since 11 am. Pt reports vomiting X 1 approx 1 hour after being bitten. Denies nausea at this time. Pt appears anxious at this time. Awaiting MD eval.

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The guy was telling the truth. He was very anxious and his abdomen was rigid, which are true symptoms of a black widow bite. He received some IV muscle relaxants and went home about 6 hours later. I have no follow up to know if his penis fell off.

-ER Doc