Subaqua Sternal Rubs

Welcome to a new category: stories of my adventures in an Emergency Department in New York's Capital District. (And for those of you from out of state, that's not New York City.)

Just in case you didn't know, evidently crack rock mixed with cocaine is extremely flammable. (Or is it inflammable - Dr. Nick) At 3 am, a 50 year-old female was delivered to the Emergency Department complaining of a sore throat after being in a house fire. The ambulance drivers (side note: I hate this term, but these guys really earned it) (another side note: they were actually firefighters) brought her in BLS, even though they had ALS available. Not even any oxygen, just a taxi ride.

The woman presented with pain in her throat, some shortness of breath, and soot on her face, down in her nares, throat and on her hands. She said that she was the victim of a stove fire. However, due to a phone call from the patient's daughter, we found out that the patient was "free-basing" crack/cocaine, and thus started the stove fire after the rock blew up in her face.

The burns to the patient's face and airway caused swelling to the larynx so that less air was getting to the patient's lungs. Upon arrival, the patient's oxygen saturation was 90%. While not horrible, this value should be above 97%. Due to the increasing laryngeal swelling, the physician opted to use rapid sequence intubation, in which medications are given to relax all muscles and make the patient unconscious, and then a tube is passed into the airway to protect it and keep it open. The ventilator was then connected to the tube to breath for the patient, as medications keep them unconscious.

Upon getting the labs back, looks like our patient was having a little too much fun. The urine drug screen came back positive for methadone, barbituates, tricyclic antidepressants, marijuana, benzodiazapenes, and crack/cocaine. Actually, estimate is that the patient was in the fire for half an hour because she was so "wacked-out," she didn't recognize that the house was on fire and she should probably leave.

Now remember kids, crack/cocaine is flammable, so always practice good fire safety.

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