Hitler, Mussolini, Vlad the Impaler.... Oh My!
I got report from an outside hospital. Drunk dude got beat up. He went there and they did a Max-Face CT (they didn't do a head) and were transferring for OMFS. Cool, no worries, whatever. They gave me a history (Hep-C, ETOH abuse and cirrhosis) with plts of 17,000. They were coming by ground. After about an hour and a half no patient. I heard the helicopter get punched to that hospital for the "multiple trauma from assault." I called to find out what the fuck was going on.... apparantly the patient got loaded into the ground ambulance and "lost" an airway. The Dr attempted to intubate and was unsuccessful. He then crich'd the guy (with plts of 17!) and he was now bleeding out from the head/neck. Oh yeah... and he MIGHT have active TB. Oh and they didn't send a sample to the blood bank so they couldn't start platelets. Oh my fucking god! The nurse who called report was unable to tell me anything about the patients airway... because she had only been in the ER or 2 weeks! (before that all she did was psych!)
4 traumas from the same rool over MVC. Not a one wearing a seatbelt!!! OMAA!!
Poor lady with Lupus, ESRD, HTN ...ect ect fucking ect. "pleuritic chest pain" per the squad. On arrival she was short of breath and had a swollen tongue, neck and face that was unresponsive to benadryl, solu-medrol and sub-q epi x2. She was moved into the trauma room where anesthesia trauma surgery and ENT were at the bedside getting ready to cric her. Thank GOD she went to the OR instead. Just what I freakin need is two airway issues in one night!!!
Because I needed to end my night with a bang.... right at shift change there was an MVC. My patient was ejected and pinned between the car and the ground. Have I mentioned that the patients these days have been the size of small elephants? This was no exception. She had crushed bilateral lower legs, and open femur. On arrival (by ground) to the ER she promptly coded... which is especially shitty when you have no IV access. I pulled out the EZ-IO to drill her humerus.... but she was too fat for it! Trauma threw in two groin lines, the ED resident intubated while the trauma attending (I have called him Yoda on here before) opened her chest. Unfortunately, we were unable to get to her heart because the rib spreaders were too short for her. She was just too fat! After several rounds of drugs and 3 units of blood I was on my way upstairs backwards hanging blood. When I left the OR they were still looking for spreaders that were big enough and Ortho was cutting the leg off.
SO I am trying to decide who I must have been in a former life to deserve this! I had to have a big ol' glass of wine before i was even calm enough to type this.
Pardon the verbal diarrhea but I have to dump this on here so I don't completely blow a gasket!