... you can't win them all.
Last night I don't think I won any! Some nights everything you touch turns to gold and then there are nights like mine. Seriously, don't know where this shit comes from.
I was supposed to be walking the green mile again last night. Not in charge, just rowing with the others. One of the nurses absolutely hates the trauma room and asked if we could switch. Easy enough and the world swings my way for a change. I picked up the room from one of the guys who is both thorough and laid back. If only he worked nights! The room was both empty and stocked..fan-freakin-tastick. The trauma docs immediately decided to put one of the traumas back in the room for chest tube placement. 18 year old female, t-boned on the driver's side. Rib fractures 4-11 on the right side with a hemo/pneumo. The doc did an incredible job of numbing her and with a little "liquid margarita" (aka dilaudid) she did great.
Once she got settled, the trauma started rolling in. 3 from another accident.. nada too sick. Two rolled out and we got another upper airway burn from a house fire. This guy went into his burning house after his cat. He made it out, the cat did not. Nice 22 year old guy with a history of asthma. He was wheezing, but still managed to laugh and joke despite the house (and the cat) being a total loss. Got scoped at the bedside, and then to burn ICU for overnight observation.
Did I mention we were on diversion with very few inpatient beds? OK, just checking....
Local EMS agency overrides diversion (it happens) for a man with chest pain, in a 3 degree heart block and 10/10 pain. One thing I have picked up along the way: if you have to use a towel to wipe the sweat off, THEN use benzoin to get the 12 lead EKG and normal EKG patches to stick.... life is NOT Good today. Get your shit ready. This poor guy had a rate in the 50's, a pressure in the 200's despite 180mcg of nitro. Bad juju my friends. He was awake, talking to me while 50 million things happened around him. Hemocult, heparin bolus and drip, projectile vomiting + zofran = baby asa and plavix PO. IV morphine and titrating the shit outta the nitro. Consented for cardiac cath by the CICU and rolled out 35 minutes after hitting the trauma room. (no other bed when he arrived). He coded as soon as he hit the cath lab..... died 45 minutes later. 50 years old..... I kept telling him to hang in there and that things would be ok.
Next contestant. 86 years old, from the nursing home. Dementia, prostate cancer, vomiting blood, being bagged on arrival. The nurse didn't think she was supposed to send the DNR. We were fixing to get medieval on him as the charge nurse convinced the NH staff to fax the goddamn DNR already. It finally, thankfully showed up. He was fluffed, puffed wrapped in blankets, put on a NRB and left the hell alone. What a damn relief. In an effort to reverse my karma I grabbed a COW (computer-on-wheels) popped up Pandora on some Michael Buble and put that in his room as well. Hell, if the man is going to die he may as well have some relaxing music!
He had just gotten settled and I was feeling a little better when we got the next call. Flash pulmonary edema 2 minutes out. Pt shows up on CPAP via a transport service (not 911 type EMS). 28 years old, 450lbs from a respiratory-type nursing home. She had been short of breath for greater than 40 minutes and the facility chose not to call 911, but to wait for their normal transport service. She was awake and saying "help me" when she arrived. As we watched she stopped breathing on CPAP and the game was, unfortunately, on. Bagging her was a BITCH, I had to pull her hair just to open her airway and it took 3 of us to get a good seal. Roc and etomidate... the resident got the tube on the second look. (long story involving the dumbass attending.... better saved for a later rant) Even with color change she looked horrible. Purple and mottled no matter what we did. Confirmed tube placement a million times... she dropped her rate from 140 to 60... but never brady'd down like our shit-airway people usually do. Shit BP + Shit O2 sats.... femoral pulses impossible to feel through the FUPA and the cheese down there was disgusting. We coded her for 11 minutes the first time, and got a pulse back after 2 rounds of drugs. Lost it again after I art-stuck her for labs. Coded again for 15 more minutes.... everyone took turns with compressions as she was too big for the geezer squeezer. P's and T's... everything covered. Even darted her left chest just to see if it changed things. Over an hour of coding the big girl when we were finally done, followed by cleaning the hell outta the room and the quest for a bariatric body bag.
As we were zipping her up, my transfer... self inflicted GSW to the right temple with an exit in the left temple. He said he was cleaning the gun and it was an accident. (yes, awake and talking... just destroyed both eyes) Accident my ASS!
So on the advice of one of our university police officers my breakfast consisted of "Jameson's, 3 fingers with 5 ice cubes." Perfect for a night like that.