Medicine Sucks... Christmas Edition

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Jeff698

EM/EMS nerd
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Might as well get it started now.

Christmas Eve.

1) 19 week fetus delivered 2 minutes outside our door. Intubated but with predictable outcome. Merry Christmas.

2) 25 year old man with malignant cancer on BiPAP, loosing blood pressure and no left lung left. Will likely live slightly past midnight. Merry Christmas.

3) 60s IDDM male, cardiac arrest w/ predictable outcome. Merry Christmas.

4) 80s woman hit by car. Survives long enough to have STEMI. Predictable outcome. Merry Christmas.

5) Oodles of "my clinic is too full... go to the ER". Merry Christmas.

For everyone who worked today and will work tomorrow, take heart in knowing your larger EM family knows what your going through.

Take care,
Jeff

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This year I worked Fast Track today and tomorrow so nothing too crazy going on. Although who brings a two year old with a cold to the ED at 11pm on Christmas Eve? And there were 4 of them (not from the same family) in triage when I left!!
 
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This year I worked Fast Track today and tomorrow so nothing too crazy going on. Although who brings a two year old with a cold to the ED at 11pm on Christmas Eve? And there were 4 of them (not from the same family) in triage when I left!!

I'm hoping those that do this are doing it because they finally got time to take their kids to a doctor. Probably not the case, but I can hope.
 
19 yo female screaming hysterically brought in by parents. Girl screaming to parents, "Mom, tell me she's okay." "Dad, tell me she's going to be fine." "I should've answered the phone." The last one confused me.....until I found out her best friend called 4 hours ago, but she chose not to answer the phone. 2 hours later, another friend called saying the patient's best friend (who she didn't answer the phone for) had just been involved in a fatal car crash. And, get this, around Thanksgiving, the patient had also lost her boyfriend to a fatal car crash.

Mom and Dad knew she was going through a normal bereavement process. They just needed someone else to help out.

Poor, girl. It's stuff like that which shakes me. Who hasn't answered their cell phone before thinking, "I'll just call them back later"?

Take care, everyone, and hope you have a safe and festive holiday season.
 
family of 6 driving home from a christmas party. left early because the one son's girlfriend didn't feel well. no alcohol on board. 90 yo man runs stop sign and plows into their car...none of them are restrained passengers. dad and girlfriend dead at scene. my patient's (the other son) L1 vertebrae essentially exploded. no neuro function below T12/L1. emergently to OR. neurosurg attending thinks he will regain some sensation, but will never walk again.

i need to go to bed and forget about this one. the whole thing got to me.
 
family of 6 driving home from a christmas party. left early because the one son's girlfriend didn't feel well. no alcohol on board. 90 yo man runs stop sign and plows into their car...none of them are restrained passengers. dad and girlfriend dead at scene. my patient's (the other son) L1 vertebrae essentially exploded. no neuro function below T12/L1. emergently to OR. neurosurg attending thinks he will regain some sensation, but will never walk again.

i need to go to bed and forget about this one. the whole thing got to me.



Cold and loney christmas for me this year... but it certainly could have been worse.
 
Merry Xmas. You were pushing your husband in his wheelchair and had him lean over to push the wastebasket out of the way and hit a bump at the same time. He's on coumadin. That makes his subdural bleed much worse. Oh, he wanted to die anyway? Great. He gets his wish from Santa then.

Merry Xmas. I know you thought your husband was having an affair since he was so cold and unemotional the last two months, but the ct scan says that he is cold and unemotional because of the massive tumor, probably gbm that has wrapped itself around his frontal lobes. And of course they are the nicest couple ever.
 
Not medical but we caught a SI patient stealing another woman's purse out of her room. SI patient had admitted to triage that she had been high on crack for two days and she ran out. Merry Christmas honey, you get to detox all day and night in jail.:thumbup:
 
Two nights ago, an old buddy of mine and his whole family stopped at a Cracker Barrel on their way out of our old hometown, only to come out afterwards to find their drivers window broken out.

Just had christmas with his wifes family. All their two kids gifts were gone, laptop, camera with pictures, their luggage, and his wifes purse. Blood slung around in the car where the idiot cut his hand and climbed over seats.

And we have idiots out there saying crime punishment is too hard and that these scumbags should be given more chances... bah.
 
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Question about the 19-week old fetus:

Would anyone here consider NOT intubating?

I had one ~ 18 weeks born to a crack addict. I didn't feel badly not resuscitating at all. Even if I'd been 6 weeks off and she was a 24 weeker, I'm not sure resuscitating would have been the right call. It didn't bother the mother one bit.
 
I get the opportunity to work tomorrow (the day after Christmas). I can only imagine the onslaught of patients from PMD's sending in the patients who waited through the holidays for their illness that warrants admission.

Yup, always the worst day of the year. You can prop Grandma up on Christmas. If it makes you feel any better, it hurts worse for the internist doing all those admissions.
 
I had one ~ 18 weeks born to a crack addict. I didn't feel badly not resuscitating at all. Even if I'd been 6 weeks off and she was a 24 weeker, I'm not sure resuscitating would have been the right call. It didn't bother the mother one bit.

I agree with your choice on that one.
 
My past week: 11 year old hanging (dead), 1.5 year old shaken baby (dead), 2 weeker with apnea of prematurity who went into respiratory arrest in the ED (still vented), 3 yo with multiple depressed skull fractures from a fall from a hay loft (amish kid- alive), 20 yr old MRCP individual with bilateral aspiration pneumonia and resp failure (vented), 15 year old who took thirty 50mg benadryl tabs, twenty naprosyn, and twelve 50mg lopressors (intubated originally, but now in renal failure).

Last night: 17 year old unrestrained driver who didn't see a car coming, pulled out into traffic across a 4 lane rural highway, got t-boned, flipped the car. Prolonged extracation. Patient had bilateral first rib fractures, right sided pneumo, left sided pulmonary contusion, and amazingly, a very stable c-1 anterior arch fracture for which she bought herself a halo.

She's lucky she's alive.

It's been a helluva week.
 
Merry Christmas, indeed.

Apparently I did something right. I must have gotten all the pain over yesterday. I didn't loose a single patient today. Didn't even admit one to the unit.

Lots of patients, though. Surprisingly few trolls. The folks that came in, for the most part, really had issues. Only one or two cases of terminal hypovicodinemia.

Take care,
Jeff
 
I fly home on Xmas eve after having been away for over 2 months on externship and interviews and as we are at the Xmas eve dinner table my mom says to my younger and infinitely less responsible brother: "Why don't you show your brother you finger infection."

He shows me a gumball size abscess on his 5th digit with what appears to be a possible associated cellulitis. It was ugly!!

Although my bro has good health insurance, I knew that there would not be a hand specialist within 1000 miles of a private hospital, so I had to take him to my county zoo.

I sat with him every step of the way through registration, coercing nurses with chit chat and smiles at and it still took 2 hours to get him into fast track.

I suggest you all do this at some point. You will understand why the patients are so pissed off by the time we ask, "So what brought you here today"
 
Question about the 19-week old fetus:

Would anyone here consider NOT intubating?

honestly, as difficult as intubating a 23-24 weeker can be, i'm not even sure "intubating" a 19 weeker is even possible. i've seen experienced neonatologists have issues simply because of airway size (the tubes just don't get that small). i'd have to see it to believe it in a 19 weeker. how much did the kid weigh??

on a larger note-- if your dates are accurate, you'll never be found negligent letting this kid go. not to say you won't be sued (people can sue for anything) but i've witnessed 22 week infants go unresuscitated without controversy.

--your friendly neighborhood will take his infants 35+ please caveman
 
Damn guys. I'm really, really sorry.

Thanks for being out there while the rest of us are celebrating with our healthy families.
 
, so I had to take him to my county zoo.

I sat with him every step of the way through registration, coercing nurses with chit chat and smiles at and it still took 2 hours to get him into fast track.

I suggest you all do this at some point. You will understand why the patients are so pissed off by the time we ask, "So what brought you here today"

I know what you mean. I walked a patient through a Middle Eastern ER this week (150 bed place) where there wasn't a single caucasian present (besides the two of us) and hardly anyone spoke English. You might be interested to know that vital signs were not taken during the entire visit. :wow:
 
Question about the 19-week old fetus:

Would anyone here consider NOT intubating?

Absolutely. The grey zone starts at about 21-22 weeks. The problem is when, in the heat of the moment, the gestational age is unknown or semi-known. When guessing, ie EMS says Mom is "about 20 weeks, but maybe more", that child will get intubated. But no 19 weeker intubated in the field, or even in house, is gonna make it.
 
Question about the 19-week old fetus:

Would anyone here consider NOT intubating?
Me, but only in proportion to my level of rock-solid confidence that it's not actually a 22-week old fetus.

So in other words, probably not. :/
 
Question about the 19-week old fetus:

Would anyone here consider NOT intubating?

Call me cold-blooded, but if I were delivering the 19 weeker, I would tell you bluntly no heroics.

But then, I know the odds. :(
 
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