I Love My Job

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

southerndoc

life is good
Volunteer Staff
Lifetime Donor
20+ Year Member
Joined
Jun 6, 2002
Messages
13,856
Reaction score
4,389
Two intubations, a subclavian line, a shoulder reduction, a wrist reduction, a STEMI, an acute stroke that got TPA'd, and a DKA'er... reminds me how much I love my job!

Doesn't compare to my night a few weeks ago where I had a ruptured ectopic, two status seizures (one of which was a post-partum eclamptic), a radial artery pseudoanerysm on the verge of rupturing, an epidural bleed, a high-grade SBO, a septic patient that got lined and tubed, and yet another respiratory distress that got tubed.

Days like that reminds me why I chose emergency medicine.

(FTW, one of the intubations (the one that got the subclavian line) had a serotonin syndrome from an SSRI and cocaine... core temp? 107. That's hot!)
:love:

Members don't see this ad.
 
Members don't see this ad :)
How did you manage this one?
Consulted vascular and screwed up by admitting her to the FLOOR instead of the ICU to the service that put in her a-line. (don't ask - lapse in brain judgement I guess!). Luckily nothing happened as I admitted her at 5:30 and vascular saw her at 7:30. They took her to the OR and ligated her artery as she had good collateral flow in the ulnar artery. 4 cm is a big pseuaneurysm of the wrist.
 
awesome! i hope to be in your shoes a few years from now.
 
Wow. I was excited to have a STEMI that I pushed lytics on, a cholecystitis, a non-STEMI and a girl who thought she peed out a worm. It turns out she was just pregnant (she had been trying for 5 years, so nonetheless, she was very happy). This was an exciting shift considering I work in a military ED.
 
Sweet, glad you had a good shift.

At the very tail end of my 12 hour shift. Got to watch Late Night Poker, South Park, surf CNN and usatoday endlessly, 3 hours of sleep, and a handful of urgent care stuff. Nothing remotely exciting, and no procedures, but got paid well at $213/hr.

Q
 
...and a girl who thought she peed out a worm. It turns out she was just pregnant.

Now, was the pregnancy just an incidental finding or did it somehow explain the chief complaint?
 
Two intubations, a subclavian line, a shoulder reduction, a wrist reduction, a STEMI, an acute stroke that got TPA'd, and a DKA'er... reminds me how much I love my job!

Doesn't compare to my night a few weeks ago where I had a ruptured ectopic, two status seizures (one of which was a post-partum eclamptic), a radial artery pseudoanerysm on the verge of rupturing, an epidural bleed, a high-grade SBO, a septic patient that got lined and tubed, and yet another respiratory distress that got tubed.

Days like that reminds me why I chose emergency medicine.

(FTW, one of the intubations (the one that got the subclavian line) had a serotonin syndrome from an SSRI and cocaine... core temp? 107. That's hot!)
:love:

Sounds like a typical night in the ER!! Great job!!
 
Two intubations, a subclavian line, a shoulder reduction, a wrist reduction, a STEMI, an acute stroke that got TPA'd, and a DKA'er... reminds me how much I love my job!

Doesn't compare to my night a few weeks ago where I had a ruptured ectopic, two status seizures (one of which was a post-partum eclamptic), a radial artery pseudoanerysm on the verge of rupturing, an epidural bleed, a high-grade SBO, a septic patient that got lined and tubed, and yet another respiratory distress that got tubed.

Days like that reminds me why I chose emergency medicine.

(FTW, one of the intubations (the one that got the subclavian line) had a serotonin syndrome from an SSRI and cocaine... core temp? 107. That's hot!)
:love:

Sounds like a typical night in the ER!! Great job!!

:smuggrin: Sounds like the kinda night that got me sucked down this path.
 
107? Sheesh! In Vegas the DOAs come in with temps of 107 in March.:p

JK. Glad you had some fun days.


well, at least they come in warm and dead and you can pronounce them then.
 
well, at least they come in warm and dead and you can pronounce them then.

Neat:
Hyperthermia-induced cardiac arrest in monkeys: limited efficacy of standard CPR.
Eshel G, Safar P, Radovsky A, Stezoski SW.
BACKGROUND: Successful resuscitation from heatstroke cardiopulmonary arrest has been only partially explored and the data covering the post resuscitation pathophysiology leading to secondary arrest is, in most cases, insufficient. HYPOTHESIS: Following heatstroke-cardiopulmonary arrest, successful resuscitation may be achieved by standard CPR with surface cooling and administration of glucose. We ponder the sequence of early circulatory responses and the pathophysiological changes following successful resuscitation. METHODS: We exposed 12 pigtail monkeys to total-body hyperthermia (cerebral T 42 degrees C) until cardiac arrest ensued. Standard external CPR with surface cooling and glucose 5% IV were administered for up to 30 min. Control group A (n = 6) was compared with experimental group B (n = 6), which received additional steroid, glucagon and hypertonic glucose during CPR attempts. RESULTS: No significant differences were found between the outcome of the two groups. The 30-min CPR attempt succeeded in restoration of spontaneous circulation (ROSC) in 8/12 monkeys-5 animals from group A and 3 in group B. The animals in whom resuscitation was unsuccessful had significantly prolonged periods of rectal temperature exceeding 42.5 degrees C (p < 0.05), and significantly higher rectal temperatures at the end of 30 min of CPR and cooling (p < 0.05). All the resuscitated animals later rearrested at 158 +/- 68 (95-228) min after ROSC; pulmonary edema occurred in 6/8 animals. CONCLUSIONS: We conclude that experimentally-induced heatstroke can be transiently reversed by standard resuscitative procedures, but is followed by a delayed, irreversible, secondary shock state, which could not be prevented by the treatment we employed. We were, however, able to document in detail the pathophysiologic processes involved in the resuscitation, and the irreversible shock one sees after "successful" CPR.
PMID: 9143752
 
Neat:
Hyperthermia-induced cardiac arrest in monkeys: limited efficacy of standard CPR.
Eshel G, Safar P, Radovsky A, Stezoski SW.
BACKGROUND: Successful resuscitation from heatstroke cardiopulmonary arrest has been only partially explored and the data covering the post resuscitation pathophysiology leading to secondary arrest is, in most cases, insufficient. HYPOTHESIS: Following heatstroke-cardiopulmonary arrest, successful resuscitation may be achieved by standard CPR with surface cooling and administration of glucose. We ponder the sequence of early circulatory responses and the pathophysiological changes following successful resuscitation. METHODS: We exposed 12 pigtail monkeys to total-body hyperthermia (cerebral T 42 degrees C) until cardiac arrest ensued. Standard external CPR with surface cooling and glucose 5% IV were administered for up to 30 min. Control group A (n = 6) was compared with experimental group B (n = 6), which received additional steroid, glucagon and hypertonic glucose during CPR attempts. RESULTS: No significant differences were found between the outcome of the two groups. The 30-min CPR attempt succeeded in restoration of spontaneous circulation (ROSC) in 8/12 monkeys-5 animals from group A and 3 in group B. The animals in whom resuscitation was unsuccessful had significantly prolonged periods of rectal temperature exceeding 42.5 degrees C (p < 0.05), and significantly higher rectal temperatures at the end of 30 min of CPR and cooling (p < 0.05). All the resuscitated animals later rearrested at 158 +/- 68 (95-228) min after ROSC; pulmonary edema occurred in 6/8 animals. CONCLUSIONS: We conclude that experimentally-induced heatstroke can be transiently reversed by standard resuscitative procedures, but is followed by a delayed, irreversible, secondary shock state, which could not be prevented by the treatment we employed. We were, however, able to document in detail the pathophysiologic processes involved in the resuscitation, and the irreversible shock one sees after "successful" CPR.
PMID: 9143752

Now we have to warm if cold, and cool when hot?? Can't we just use a thermos - they somehow know the right thing to do in all circumstances!?!
 
Top