Another busy evening in the ER...

[Nephrology]

Around my way in our level 1s it's a bit more colorful...

It probably depends on the way your city hospital system is set up, but the institution where I am doing my preceptorship is the busiest Level 1 trauma center in the time zone. We still probably have a 4:1 ratio of medical:trauma patients, even on Saturday nights (it does shift towards trauma in the summertime).

Not because we have less trauma than other mid-sized cities, but largely because there are more medical problems than traumatic injuries. This is true nationwide - even (maybe especially) in the worst cities/neighborhoods in the US. For every homie who solves their problems with a Hi Point there are 10 others who have chronic conditions that are being under treated or not treated at all. These people dip in and out of the ED multiple times over the course of their lives because it's the only place they can get access or think to get access to healthcare.

I suspect some of your perspective might be from the patients you bring in/reasons you visit the ED, but it also might be true that your local trauma center is dedicated for trauma specifically. There are a few places out there like that (i.e. Shock Trauma in Baltimore), and in bigger cities there are usually so many EDs that some end up more or less functioning that way (King's County & Bellevue in NYC). Would be curious to know more if you want to PM me.

When my oldest was in HS, they did rotations through many of the departments at two local hospitals.
It was part of a HS class for kids intending to pursue health-related careers.

First week was Labor & Delivery... Two natural births and a Cesarean.
Next week was PCU... Two Pts taken off life support. Missed observing an organ harvest to make room for a Nurse (RN) to observe at last minute.
Lots of great learning (some of it quite heavy stuff) for a 17/18yo.
Two rotations through two ER's (all during the morning/weekday shift) were pretty uneventful compared to other departments.
Worst rotation was pulmonary & respiratory care... Blood was no problem, but apparently suctioning phlegm was too much to handle.
Unicuique sua.

Great thread!

deep suctioning is pretty uncomfortable for everyone... especially the patient.

Glad they got the chance to see that. I think everyone should spend at least an afternoon in an ICU, too - if only to convince them to 1) not drive like idiots and 2) fill out an advanced directive, goddammit.

[breakingtime91]

Completely agree on the directive. After spending multiple days in a ICU with my brother and ultimately making the decision to pull him off Life support, I figured out I never want my wife to go through that with me. Pull that shit if I'm gone, exact words I said to friend who doubles as an attorney.

[JCS]

The Lucas device is quite interesting for sure. If you want to see another crazy device, lookup cardiopump. We starting using it awhile back, with great success from what I hear. It's basically I giant suction cup that attaches to the chest.

Nephrology, how does the handoff of the body to the ME work at a hospital? Our guys in the field have gotten in trouble for simply removing an et tube after calling a patient.


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[Nephrology]

Completely agree on the directive. After spending multiple days in a ICU with my brother and ultimately making the decision to pull him off Life support, I figured out I never want my wife to go through that with me. Pull that shit if I'm gone, exact words I said to friend who doubles as an attorney.

Yeah, I filled one out specifically so that if I was ever unresponsive and needed a decision like that made, my mom/brother/etc could read what I want for myself, in my handwriting, and be comfortable making that decision. I am so sorry about your brother - I couldn't imagine doing the same. Definitely want to spare my loved ones that anguish if it ever comes to that (knock on wood).

The Lucas device is quite interesting for sure. If you want to see another crazy device, lookup cardiopump. We starting using it awhile back, with great success from what I hear. It's basically I giant suction cup that attaches to the chest.

Nephrology, how does the handoff of the body to the ME work at a hospital? Our guys in the field have gotten in trouble for simply removing an et tube after calling a patient.


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Cardiopump looks pretty interesting. Haven't seen those before, but I'll ask about them next time I get the chance. My preceptor has a lot of research interests - cardiopulmonary resuscitation in the field is one of them. He usually has pretty interesting things to say.

It depends on which ME as there are a number of counties that intersect the Denver metro area. They bag the hands if they suspect the pt might have used a gun prior to death (SIGSWs) and we close the thoracotomy incision (if there is one) just to sort of, uh... keep it all inside. We usually ask if we can move the cadaver out of the resuscitation room as those are usually in high demand - if they say yes we wheel the gurney into a side room until they come to pick it up, which can take a bit.

[ST911]

Ah, the LUCAS. Robbing legions of rescuers the opportunity to enjoy exhausting compressions on extended transports.

[SeriousStudent]

two words: resuscitative thoracotomy.

So they frown on Teva's now? But they were so convenient, just step in a big pan of bleach......





(Just kidding, we never had bleach.)

[Nephrology]

So they frown on Teva's now? But they were so convenient, just step in a big pan of bleach......





(Just kidding, we never had bleach.)

Saving those for my family medicine rotation.

[dkv]

So they frown on Teva's now? But they were so convenient, just step in a big pan of bleach......





(Just kidding, we never had bleach.)

I was wearing crocs while at the head of the bed of an elderly bicyclist who had an open skull fracture. The brain bleed briskly, and filled the crocs up, like little swimming pools.

They were easy to clean out. I might still have them.

[voodoo_man]

In the summer, usually Thursday through Saturday evenings, our police radio will randomly come over and tell us which hospitals are on divert in case we have to scoop and go.

Mind you we have 6 level 1 ERs three of which can handle 10-15 seriously injured persons at a time and they are pretty efficient.

We usually get at least one or two put on divert for any level 1 type injury.

One night specifically, we were so busy my radio dispatcher didn't get a chance to put out that a very close level 1 was on divert and my partner and I scooped a guy who had been stabbed several times. On the way there I was working on him best I could and when we got there the doctors started yelling at us because they had no where to put him. They just brought a bed and started right there in the hall. Bringing everything they needed to the location from the rooms. It was nuts because they thought I was injured since I had most of the guys blood on me. But I was just on the guy trying to stop him from bleeding out.

He didn't make it

[YVK]

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.

If you remember those triangular leaded groin / gonad rad protectors, with long strings attached to go around the waist, we had somebody wrap them around the neck instead of a thyroid shield for the in-lab CPR.


As far as shoes and blood: I cant stand shoe covers, loss of traction etc. I use my old, worn out tennis or running shoes for the lab procedures and replace them when they start looking like I just butchered someone. A pair usually lasts a year, maybe more.