Wednesday I walked in to a 53 year old terminal cancer (mets everywhere) patient who had gone to his hospice appointment that morning then went down in respiratory arrest that afternoon. He didn't have a DNR yet so the squad hit him with the full court press. He was tubed, with a pressure of 80 when I showed up. I also had a 63 year old acute renal failure patient with cancer everywhere (notice a trend?) who came in for leg swelling. She was tachy, hypotensive (80's again.... they took turns being the lowest in the dept) and had a K that started at 6.5 and INCREASED after the kayex, D50 etc to 8.9. She refused dialysis before being taken to the ICU. Not gonna be good! My other two patients were a 40-something HIV, MRSA ESRD patient with a pneumonia who was trying to get septic and a 20ish female with non-cardiac chest pain. She got an attitude when I didn't spend enough time in her room. All she wanted was narcotics. Once I got those 4 patients all out (about 6 hours later) life got easy and the rest of the night was cake!
Thursday night started the same. Drug-seeker with the typical manipulative behavior after a MRSA infected spider bite. Sickle cell patient who wanted me in her room. Alcoholic with a hgb of 5.2 and a 91 year old passenger from a slow speed mvc. Her 84 year old husband with a prosthetic leg ("a gift from the Germans") was driving her from her women's meeting and lost control of the car. She was having some chest pain from the airbag being deployed. I had a bad feeling from the start..... her EKG was fucked up... but the doc's wouldn't get in there. When her heart rate dropped to 30's they finally paid attention.
She stayed very stable considering she had a new, trauma related right bundle branch block. We floated transvenous pacer wires at the bedside before she went upstairs. I love little old people (90's) they are hysterical. This one was sharp as a tack. When I told her that her heart rate was slow, her response "well so am I." She met her husband at Walter Reed Army Hospital during WWII. She was in charge of entertainment for the troops. She met all of the 40's movies stars (Will Rodgers was her favorite), knew Gen and Mamie Eisenhower well, and was friends with the socialite who owned the Hope Diamond. She has actually worn the thing!!! She and I hit it off from the moment we met and as sick as she was, we enjoyed just talking.
As her pacer wires were going in, my alcoholic started getting blood.... it was a hell of a start. Later that night we had a police pursuit that ended up in a pretty bad accident. The bad guy and his girlfriend were driving like maniacs and then didn't stop because he had a suspended license and didn't want to go to jail. The two shitheads showed up first. He was pretty much fine, she had two broken arms and kept screaming. I leaned down to her ear and did the best impression of my mom when she was pissed off. Pretty much the evil whisper that told her she wasn't the sickest person in there, she needed to grow up and shut the hell up. It took 45 minutes to cut the officer out of the car. They had the road from the crash scene to the hospital completely shut down for the ambulance. Poor guy will survive, but is sick as shit. Other than the multiple ortho injuries, his CT looked like this.....
Not his actual CT, but close. The heart is in the center, the right lung is on the left (CT's are reversed) and that area on the pt's left (our right) is stomach. No, there is NOT supposed to me stomach in the chest cavity. Poor guy ruptured his diaphragm. The internal pressure to the abdomen causes the weaker side of the diaphragm (the left, due to the heart) to blow out. Its a bad injury.... but being that he was young, he should be ok.
I've gotten calls for 3 flight shifts in the past 24 hours. Too bad I can only do one of them. I did pick up another one New Year's Eve in Md. The cop has to work, so a little double time for 24 hours with a free hotel room won't hurt!!!