Door Time

We joke about the bus full of little old ladies that are all hard of hearing and on coumadin that hits a bus full of non-english speaking hemophiliacs in a van full of razor blades. Its the perfect storm for a big trauma.

I was not in the trauma room Saturday night. I had a zone and was fine with it, thank you very much. I just so happened to answer the phone call from triage that told us we had a pt on a motorcycle that was shot in the left chest and then wrecked the bike. Our eta was 10 minutes... they showed in 3. The patient had a c-collar on, was COLD and clammy to the touch and was screaming that he wanted his collar off. His first blood pressure was 80 systolic (he was laying down at the time) and his rate was 140's. No huge blood loss on the outside, but he looked like shit. The trauma doc wanted an upright chest X-ray to see what it had hit. As soon as we sat him up, his pressure went to 60. I was hanging blood before the doc had the trauma line in. He was packaged and expedited to the OR. When his chest was opened he had a hemo-pneumo on the left, a posterior aortic injury (good thing his bp stayed low!), a pneumo on the right and the bullet ricocheted through the diaphragm and ended in the stomach. Amazing!

Our front door to OR time..... 11 minutes! That was with him fighting. Not to shabby. I spoke to the medic later and from our estimation his injury time to OR door time was less than 30 minutes. That's pretty fucking good.

When you get a great team together things just flow like that. We did a stroke alert at 650 this morning. There was another great team on and we had EKG, labs, CT scan done in less than 10 minutes. He was getting tPA at 715 and had started to resolve his symptoms when I left at 730.

It is starting to get warm here. Traumas are back to back non-stop and people are starting to aim better. JCAHO is going to be here any week and our ER admits are through the roof. Spring has obviously sprung.

And so it goes...

Why is it that when one opportunity presents itself another pops up behind it? I applied for one flight job.... its a long drive, but a great program. On the way to Buffett I got a phone call from a friend who is a flight crew member at my hospital. He wanted to give me a "heads up" about a position opening at one of their bases.

My former partner (the Squirrel) has some connections at the second base and may be able to grease some wheels for me. These things take time and I don't expect phone calls for several weeks (could be as long as a month or so). In the meantime I need to tighten up on my drips, cardiac (my main weakness) and generally get ready for what I'm sure will be the next great grilling of my life.

and so it begins again.......

Missing the Penguin

Am starting to apply for flight jobs again. With the economy the way it is, I know that they will be few and far between. I'm not counting on anything nearby. I doubt I will ever find another helicopter base that is 20 minutes from my house. So I've applied and we will see if I get a call back.

One of the bitchy nurses from the ER applied to a program as well. She wants to do fixed-wing and its way the HELL out west somewhere. Bon chance and Bon voyage as far as I am concerned. Smart girl, but I won't miss the attitude.

I miss flying every day. The sounds, the smells that feeling when the pilot is getting ready to pull pitch and TA-DAA you're outta there. When the cop drives I still think "clear right" in my head at turns. I opened the trunk of my car today and found my pillow and comforter from the base as well as my helmet wrapped in the comforter. It still has the crazy penguin sticker on the back (like the one above) and you can see where I used to fiddle with the chin strap. I had another sticker I bought for it too and never got a chance to put on there.

So we will see what comes next. The easy road is never the best one, and the rocky road builds character. I think I'm turning into one of the Madagascar penguins now. (I'm the short one in the middle)

I Wanna Hold Your Hand

Its been a long time since I was this tired when I got home. We weren't that busy last night. I shouldn't really feel like this. My friend said that my circadian rhythm is fucked up. Ummmm.. no shit it is!! Thats what we love about the night shift, isn't it?

Weird shit last night. I went to the trauma room to get a blanket for the most needy, neurotic patient in the world (more on her later). Patient in bed 1 was status post motorcycle accident. He had his aspen collar on and was steady wacking off under the covers.... all the while having a conversation with the patient in he bed next door. Ewww!!!!

The neurotic lady... good god! She had afib with RVR, a recent stroke and (oh yeah) agoraphobia. She has flat out panic attacks when she goes down the stairs in her home. After 5 minutes she called because she wanted me to know that "I don't like to be left alone." She seriously wanted me to stay in her room and hold her hand! Ugh... I know there are nurses out there that can do that, but at 7pm, right after shift change when there are over 85 patients in he emergency department... I don't fuckin think so! Fortunately, she got a bed pretty quickly and became someone else's problem.

Was in a patient's room doing their assessment when I heard a voice yell "I NEED SOME HELP!" I wasn't the typical patient screaming, so I went to investigate. Nurses were running down the hall to the patient bathroom where a (very) large woman was being pulled out in a wheelchair seizing like a motherfucker. (She was being seen for arm pain) Even though I'm not a big person, I always go help. We got her out of the chair, onto the floor. When they went to lift her there wasn't much I could do. Afterwards one of the medics actually old me that I didn't want to be getting involved in stuff like that 'cause I was too little. I know it wasn't meant as a bog deal, but the statement itself bothered me

And finally, nothing like delivering a 17 weeker just prior to shift change. Mom was 19, diagnoses with chlamydia 3 days ago and now with vag pain and spotting. The baby was alive when it came out, but died pretty quickly. 8.5 oz baby boy. Its amazing what we deal with on a day to day basis. From masturbating traumas to dead babies.... this place is fucking surreal.

Bad 'Tern/Good Trauma

When things go well it really is beautiful. I love having a really good team and a really sick trauma. Unfortunately, there is a new trauma intern who is trying to make my life miserable. All surgical interns (no matter what specialty... ortho, ENT, plastics etc) have to do different rotations through their first year out of med school. This dickweed is an ENT that had to spend a month in the ER back in the fall. He and I have already gone toe to toe on more than one occasion so I was unthrilled to see that he is the new 'tern.

When our traumas are worked up they get a trauma assessment by the resident (the 'tern is an assistant), labs, x-rays and then they go to the CT scanner. If it is a stable patient then they go to CT with the 'tern and a medic (our medics go for airway and monitoring). The 'tern can't really DO anything, because if something goes wrong either myself or the REAL doc will come fix/help the medic. So this patient is fixin' to go to CT and as the medic rolls out the 'tern is playing on the computer with no obvious intention of getting up. When I asked if he was going his response was... "thats the medic's job, isn't it?" Oh boy.... lets NOT go there with me. (er medics are treated like shit by most everyone... and it pisses me off. they work really hard and have more experience than the interns that they babysit). I told Mr 'Tern that no, in fact, he has to go. When he started to argue I told him No, No, you really are going to go over there. So you'd better catch up or I will be paging the chief. (the evil ER bitch was comin out). He rolled his eyes but he went.

Grrr..... it was on like fuckin' donkey king after that. He didn't say a WORD or write an order without someone looking over his shoulder. This month is gonna suck!

The highlight was ANOTHER self-inflicted GSW to the chest (what the hell?) that was flown in. The team worked well, got blood in quickly and were bustin ass for over 2 hours to get this guy stablized to go to the ICU vs OR. Blood, FFP, chest tube and a bronch later he was still unstable. He went to the OR and last I heard is doing well. It was SO quiet in that room during his resuscitation.. I was loving it. The chief, who I had threatened to page earlier, used to be a paramedic so she has a very calming presence. We also happen to get along great because her girlfriend was my preceptor when I was a new grad. Most of my strength in trauma comes from her. I even got a compliment from the trauma attending after the case. (I best the 'tern was hating life then!)

What can I say... I love a good trauma!

Back to the Grind

Haven't been sleeping well. Working all the time. What else is new?

Darwin Award Nominee shot himself with a shotgun. Instead of hitting the left chest (where he aimed) he blew out his axilla. Through and through had me pulling pieces and parts out of the hols as well as the wad that the pellets were in. There was blood everywhere.... poor flight crew needed a shop vac to clean the aircraft.

The male nurse that killed that sweet old lady is now cleared in the trauma room. Someone who cannot prioritize a simple 4 patient zone should not be in the trauma room with the sickest, craziest and most unstable patients. Who makes these freakin decisions?

Woody Woodpecker Eat Your Heart Out

Am still stewing over the court stuff. The attorney didn't even talk to me before the case so he didn't mention that the bitch was drunk (.32 anyone?). The judge ruled that there was no evidence to suggest that she was anything but lucid and had the right to pull her IV's, run like hell and strike out "in her own defense." Ugh..I think I want to puke. But as some people much smarter than I have said... what goes around comes around. God I hope so!

Walking the Green Mile last night. Some interesting commentary there. Guy got popped in the eye by a brother in law and was transferred halfway across the damn state to my room. By that time his eye looked something like this

So we got to do an emergent lateral canthotomy. Essentially cutting the canthus (outer corner) of the eye and down into the space to cut the ligament and attempt to free the optic nerve from a HUGE amount of blood that was pressing on it. It was pretty fucking cool, but I doubt the sight will be saved.

We also had a chick come in via EMS with the chief complaint "I have a woodpecker in my ass and it keeps poking me."What do you actually say to that?

Court

So I went to court today for the bitch that hit me. She got off.... I'm PISSED. So I'm drinking Maker's Mark and Coke and toasting open season on ER nurses. I will explain more when I am a bit more sober.