$#!^ Happens. And You Brought...?

Summer in SoCal is everything you've heard about. Really.
I'm off for the weekend. Cruising down the street listening to my own song mix. The birds are singing. Not a cloud in the sky. And over there is a white haired woman face down in the street. Not a care in...

WTF? Why is grandma doing the dead fish impression off the edge of the curb?

So I pull over smartly, hop out with my first aid kit from behind the seat, and step over to where she lies.
She is, happily for both of us, conscious and breathing, so we chat.

Turns out moments ago (Why in front of me? Just lucky like that...) she negotiated a tall curb badly coming out of the jewelry store, tripped, with both feet on the curb, and fell to the street. As she's telling me this, and giving the okay for help, I tenderly pull her out of the traffic lane in which she was laying, noting her bilateral ankle pain and tenderness.

(And nota bene, total number of helpful bystanders who come over to assist, in front of three open business...zero, start to finish. Plan on that and you'll never be disappointed.)

I'm in town, and can call 9-1-1 while simultaneously cracking a couple of ice packs, after assuring myself that her feet have good pulses, are warm, and she can wiggle her toes. While also noticing she's probably broken both her ankles, at the tender age of 70-something.

So rather than having to splint both of her lower legs, I can wait the 110 seconds it takes for the city's red-engine pride to arrive, while I gather a quick history and baseline vitals, less BP, because I can hear the truck coming before I could deploy the cuff.

She is gently loaded on a gurney, to be whisked to the local ER, in little more than the time it took to write this, and other than handing the lead paramedic all the meat and potatoes of his run report, I'm done, and ready to depart. It also helps that he and the captain both recognize me from multiple contacts in that same ER, even though I'm not in scrubs at the moment.

The point, gentle reader, is that $#!^ happens anywhere. Are you prepared for that? You'll use a first aid kit in your lifetime one helluva lot more often than a gun, so whether or not you have a CCW and a weapon, where's your aid kits?
D'ya know what to do after you grab it?
Note I said kits, not kit. If you have a weapon, you should have an IFAK/blow-out kit on your body, as well as a mini-kit, and a disasterpiece theatre SHTF kit in the car, 24/7/365.
Mayhem doesn't send warning notices. He just shows up.

 

Can you quickly assess, evaluate, and treat someone you come across who needs medical attention? How about when you go shooting? (Of course, we know you'll never have an accident, because infallibility, but what about all those other jackasses waving guns around? Haven't you seen the bullet holes everywhere but downrange??)

Everybody carries one of these:

Okay, nice, provided you've got contact bars.
Some of you carry one of these:

Cool. Now, use it to stop bleeding. Can't do that?
Maybe it's time for one of these:

And one of these is even better:

 

For some problems, there's no other work around. You simply must have the proper tool, or you can't do the job. And waving your gun, or your arms, (or some other worthless anatomy) at the problem won't fix things.

Please, don't be that guy.
Naked and Afraid isn't even much good as a reality show, but it's orders of magnitude worse as a plan for coping with emergencies.

As a wiser man teaching field medical care once pithily explained,
"If you ain't got a kit, you ain't got $#!^."

 

Not the happiest ending in this case, but better than it could have ended.

 

Life happens. Tag, you're it...

Plus ca change...

Two lifeflight traumas, three psych patients, an ICU admit whose AICD kept firing in the ED, and two obnoxious drunks. Not a bad first orientation shift on a new assignment.

Nice to be back home.

Emergency Vs. Not So Much

For the benefit of about 85% of those of you who visit Emergency Departments annually, this helpful guide:

Having a heart attack: Emergency
Not giving you a pillow during your heartburn: Not So Much

Having a stroke: Emergency
Not getting you a cup of ice: Not So Much

Having acute appendicitis: Emergency
Not letting you eat your flaming Cheetos while we rule out appendicitis: Not So Much

Having febrile seizures: Emergency
Not letting you have 27 warmed blankets with an oral temp of 103F: Not So Much

Admitting you for acute status asthmaticus: Emergency
Not fetching you OTC cough syrup during your asthma attack treatment: Not So Much

Your child having bacterial meningitis: Emergency
Not allowing you to bring in the seven not-sick siblings to the same room: Not So Much

Admitting you for suicidal ideation: Emergency
Not getting you a blanket, a pillow, two turkey sandwiches, three orders of juice, and two varieties of crackers while waiting for a transfer to a psychiatric facility for same: Not So Much

This is not intended as any sort of comprehensive list, but I offer it as a guideline, to assist you in deciding firstly whether or not to come to the Emergency Department at all, and secondy to further assist you in Shutting The Eff Up vs. complaining to my supervisor about my alleged attentions or failings regarding any of the above situations, and perhaps towards explaining why, after your piehole closes regarding such complaints, their response is hysterical laughter, and a hasty exit from your room to go deal with actually important things.

If afterwards you really feel peeved off about things, do what most people do: don't leave me any tip in the tip jar, and don't go back to that restaurant, m'kay?

As a bonus, if you think you might wish to elope from the ED at any point, I heartily suggest you do so while still in your car before even darkening the door mat on the lobby door, rather than after taking up 4 hours of valuable time when I and your doctor(s) could have been treating one of the other patients for actual emergent illnesses and injuries instead of wasting it on your drama queenery. For you, there's Oprah, not the ED. Just drive the eff through and go back home, and I won't mind a bit, pinkie swear.

And it's also why if I ever meet Mr. Press or Mr. Ganey alive and in person this side of the hereafter (or even beyond it), I'm going to tenderly and lovingly beat the ever-loving shit out of them with my bare hands until the desire to continue to do so passes away, and/or they do. Nothing less will suffice, and it will be worth the charges, I promise you. I'll probably only be able to raise several million dollars in legal defense funds, if I only get a dollar apiece just from my medical colleagues. (Seriously, you two, you're that evil and worthless, and you should kill yourselves now as a service to humanity, ideally by setting fire to yourselves inside your corporate offices with all your employees locked inside, and I'm not kidding about any of that one little bit.)

Hear me, God.

How To Tell This Isn't Going To Be A Good Shift, #2,317

Open wound + flies = party!

So you know things aren't going to be fun on your shift:

A) When the radio call report is "infected leg, with maggots".
B) When said patient arrives with the leg involved wrapped in a plastic trash bag from toes to thigh.
C) When the paramedics are taking hits off their SCBA breathers.
D) When the patient is assigned to your zone.
E) When, as part of the meet-and-greet, you have to remove the bag to visualize the situation.
F) When the funk miasma coming off the leg would knock a buzzard off a pile of guts, and you haven't even gotten the socks and pants off yet.
G) When you finally get to the base layer, and are greeted by a menagerie of several tens of thousands of little brown rice grains, all doing the entomological version of "The Wave", in a pile an inch thick. Bless their hungry little hearts.
H) All of the above.

Back off, everyone, this one is all mine! Sigh.

I would like to sound heroic, but in fact I contented myself with doing the usual business-as-usual primary assessment and trying not to flinch or start itching all over.
The arrival time being a-quarter-to-day-shift (what else?), my uninvolved co-workers' foolish curiosity overcame any native common sense or desire for self preservation, and while I happily avoided any little friends when patient decided to command spasm the leg (Dude, seriously?!), they busily applied sterile saline and suction, and vacuumed up upwards of 10,000 of the little nibblers, after doing a photo-documented wound assessment at my behest. Some things require photographic proof for posterity. 

They are my heroes for stepping up to the plate.

The maggots probably saved the patient from gangrene. Pity.

And day shift received their patient all buffed and fluffed, and ready for the metric shit-tons of sepsis-thwarting antibiotics necessary. And by the time they got there, the patient was the only living thing in that bed.

But I don't think any of us there in the room will be eating any fried rice for awhile.

Wracking my brain here, but I'm pretty sure they never mentioned the true technicolor glamour of this job in nursing school.
But I spared you any of the illustrative internet pictures at the header.

You're welcome.

Waiting For The Other Shoe To Drop

Sadly for the drama quotient, life is just chugging along, and things at work have mellowed out considerably. Sunshine does a lot to end flu epidemics when people here decide to go outside and play, instead of all sit inside and share cooties.

I'm a little worried, because usually the one constant at work is suckiness in equal measure with sickness, but no complaints on that score. I just keep waiting for some enormous disaster to hit.

While we now have far less staff people to see far more patients (Hey, thanks, HopeyDopeyCare!) the numbers are still cruising in the happy days of spring trying to become summer. Next fall/winter will be another story.

And confounding all expectations, someone has evidently threatened biblical levels of wrath on the local university, famous for providing the staff at Callous Bastard Hospital with a weekly chance to play "Guess The Coed's BAC" in years past. I was almost at the point of offering to make their institution the subject of a weekly sojourn to the city council just to provide them with bad press, but it appears the local paramedics, FD, and PD were tres pissed off about things as well, and suggested to the dean of student affairs, and more importantly to their CFO, that they would start billing the university for every ambulance call after the first one for victims of ETOH, at a round cost of $2K/trip. That took all the fun out of things, and apparently The Word was passed to every frat, sorority, and dorm:
"Knock that shit off, knuckleheads, or daddy's getting your ass back after we expel you."

And people say today's kids can't learn!