Another busy evening in the ER...

[Nephrology]

two words: resuscitative thoracotomy.

[Nephrology]

also, for more detail, because it is relevant :

Pt whose blood is on my shoes in the above photo came in with 1x 9mm cal GSW to the anterior chest, left sternal border, with an attached Lucas device that was running "CPR" for EMS x20min. Trauma surg was ready to pronounce him when he came in but nursing got 2x manual BPs on him so trauma cracked the chest. Ran their usual thoracotomy protocols, weren't able to get proper ventricular filling even with 3x units of blood and a bunch of saline via EZ-IO thru rapid infusers. Intracardiac epi was unsuccessful, no ROSC, pronounced at 1815 local time.

After the arrest I ran through the anatomy of the thoracotomy with my preceptor - he had me feel for the aorta/esophagus through the thoracotomy incision, as well as the pulmonary hilum (site of the GSW, incompatible with life) and the heart itself. Did some manual ventricular compressions on the heart, got to see the anatomy up close and personal. Incredibly educational moment. I closed the thoracotomy incision for the coroner with a (bad) simple running suture.

also had another GSW come in that night, this was 1x 9mm cal bullet to the superiomedial knee, exited then pierced the calf. Obviously self inflicted, "accidental" because homie was a convicted felon who can't own guns. He got his hands bagged for powder residue and subsequently under arrest by DPD officers. Pretty funny watching him try to convince the office that he "got jumped by a black dude, kind of chubby," and that he didn't try to discard the magazine of 9mm ammunition they found at the scene near his blood trail...

[Paul D]

You should probably wear shoe covers or cowboy boots like every trauma surgeon at my place. Shoes ain't cheap, man. Sounds like an good learning night.

[Nephrology]

You should probably wear shoe covers or cowboy boots like every trauma surgeon at my place. Shoes ain't cheap, man. Sounds like an good learning night.

Incredible learning night, and yeah, shoe covers were available, but it was pretty late and I was thinking about 1001 things at the time and none of them were my shoes. Time for a new pair anyway - those are pretty old. I'll bleach them and use them as backups.

[Paul D]

Incredible learning night, and yeah, shoe covers were available, but it was pretty late and I was thinking about 1001 things at the time and none of them were my shoes. Time for a new pair anyway - those are pretty old. I'll bleach them and use them as backups.

Of the 1001 things you have to think about, it's okay to think about taking care yourself. I remember seeing a medical student rushing to take part in his first STEMI trying to put a shoe cover over his head thinking that it was surgical cap.

[Nephrology]

Of the 1001 things you have to think about, it's okay to think about taking care yourself. I remember seeing a medical student rushing to take part in his first STEMI trying to put a shoe cover over his head thinking that it was surgical cap.

Haha, well, though I haven't yet done that exactly, your point is well made. I'm good at not jumping in over my head when I am in the clinic and know my limits very well. That said my work/life balance can always use a little improvement...

[voodoo_man]

Seen that happen before, our trauma ERs allow us to be inside when they work. Always good to see things like this as it gives you a better understanding of how the body work...And how to make it not work so well.

[breakingtime91]

also, for more detail, because it is relevant :

Pt whose blood is on my shoes in the above photo came in with 1x 9mm cal GSW to the anterior chest, left sternal border, with an attached Lucas device that was running "CPR" for EMS x20min. Trauma surg was ready to pronounce him when he came in but nursing got 2x manual BPs on him so trauma cracked the chest. Ran their usual thoracotomy protocols, weren't able to get proper ventricular filling even with 3x units of blood and a bunch of saline via EZ-IO thru rapid infusers. Intracardiac epi was unsuccessful, no ROSC, pronounced at 1815 local time.

After the arrest I ran through the anatomy of the thoracotomy with my preceptor - he had me feel for the aorta/esophagus through the thoracotomy incision, as well as the pulmonary hilum (site of the GSW, incompatible with life) and the heart itself. Did some manual ventricular compressions on the heart, got to see the anatomy up close and personal. Incredibly educational moment. I closed the thoracotomy incision for the coroner with a (bad) simple running suture.

also had another GSW come in that night, this was 1x 9mm cal bullet to the superiomedial knee, exited then pierced the calf. Obviously self inflicted, "accidental" because homie was a convicted felon who can't own guns. He got his hands bagged for powder residue and subsequently under arrest by DPD officers. Pretty funny watching him try to convince the office that he "got jumped by a black dude, kind of chubby," and that he didn't try to discard the magazine of 9mm ammunition they found at the scene near his blood trail...

Maybe I'm weird but that sounds like a fun night. I love learning, especially when it's hands on for my future profession.

[LittleLebowski]

Hydrogen peroxide.

[ST911]

Seen that happen before, our trauma ERs allow us to be inside when they work. Always good to see things like this as it gives you a better understanding of how the body work...And how to make it not work so well.

So much this. A&P is useful in a variety of pursuits beyond EMS/medicine.