Cool Story Bro’, Tell it Again

As I walked into the ED to start my shift yesterday I overheard the attending on the phone “We could take two level 1’s, a level 2 and about 5-6 walking wounded”.  After another moment he hung up and turned to the charge nurse. “There’s been a major accident and we’re going to have incoming casualties”.  Overhearing this, I could help but doing a little internal fist pump. While obviously I am not excited about people getting hurt, it’s phrases like “incoming casualties” that get your blood pumping and adrenaline flowing, and it’s one of the reasons I love this job. Things rarely turn out to be as bad as they initially sound and we ended up getting  only 2 level 2’s and 3 walking wounded, plus a few just walking. The shift didn’t let up from there and I can’t think of a shift where I have been running like I was on this one.  It was the first shift were I was managing several really sick people all at once. And while it was hectic, and I probably did a wretched job on my charts, and probably effectively ignored my not so sick patients, I think I did okay in the big picture. I had one guy trying to bleed death out his rectum, another trying to cut off his own oxygen supply, another getting all septic with a hemoglobin of 5. And I had a 1st year medical student trailing along all night who had me constantly fighting the urge to blurt out “Just please stop asking questions for 2 minutes so I can write one complete sentence in my chart here without being interrupted by something”.  Not to mention the drunk assholes who were trying to land spit luggies on our desk while we worked. Which was fun in a way as I got to blow off a little steam breaking out a few pressure point control moves while we restrained and masked the guy. Who by the way, was later seen making out another drunk patient in one of the back hallways of the ED, while still restrained.  So overall, yeah, it was a pretty awesome night and I pretty much floated home through the late night lights of the city.

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on December 4, 2011, in Emergency Medicine, Residency, Uncategorized. Bookmark the permalink. 6 Comments.

  1. That sounds like a great night. I’m a third-year and trying to see if there’s anything else I love like I love ER, but the night you just described sounds like exactly my kind of party.

  2. Best “incoming” case from the triage board this week:
    Epileptic Brachycephalic French bulldog vs. bakers chocolate- ETA-ASAP

    Apparently the people wanted to induce vomiting at home with hydrogen peroxide. In their already symptomatic dog with serious underlying condition AND a predisposition to aspiration pneumonia. They were told it would be a bad plan, and agreed to come in. Reception said the conversation went something like: “But my dog’s already ON phenobarb and KBr to stop seizures!…He can still have them? You sure? ….And the chocolate can make the heart stop [tachyarrhythmias–>CA], AND cause more seizures? Fine. We’re on our way.”
    Cause seizures..whatev!! But cardiac arrest? I *guess* that’s worth a trip to the ED.

    • Why DO dogs have such a problem with chocolate?

      • TL;DR version: Dogs (and cats) are much slower at metabolizing theobromine. A small amount goes a long ways for them. Caffeine is ALSO much harder on dogs than humans. One of the worst tox case of chocolate or caffeine I’ve seen, was dark chocolate covered espresso beans vs. small dog.

        Longer answer, from the ASPCA Poision Control FAQ:
        Chocolate can contain high amounts of fat and caffeine-like stimulants known as methylxanthines. If ingested in significant amounts, chocolate can potentially produce clinical effects in dogs ranging from vomiting and diarrhea to panting, excessive thirst and urination, hyperactivity, abnormal heart rhythm, tremors, seizures and even death in severe cases.

        Typically, the darker the chocolate, the higher the potential for clinical problems from methylxanthine poisoning. White chocolate has the lowest methylxanthine content, while baking chocolate contains the highest. As little as 20 ounces of milk chocolate—or only two ounces of baking chocolate—can cause serious problems in a 10-pound dog. While white chocolate may not have the same potential as darker forms to cause a methylxanthine poisoning, the high fat content of lighter chocolates could still lead to vomiting and diarrhea, as well as the possible development of life-threatening pancreatitis (…)

  3. Actually related to the post– I agree with you: I also enjoy working the complicated cases and busy shifts. Seeing patients walk out the door when they are [mostly] better or at least stable is pretty damn cool, especially when they arrived close to death. There’s also the adrenaline rush of working on the critical and complex cases. They can be exhausting, but you learn so much every time, and they can be VERY rewarding. Heart breaking, too. But even with the heartbreaking ones, knowing I can ease the journey and make it less painful (emotionally, physically) helps. (And the weird sense of humor that pervades the ED and ICU. That helps a lot, too.)

  4. Its really cool bro….Very nice video and i got many steps to learn and so nice post.

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