Subaqua Sternal Rubs

The McDonaldization of our society has caused everybody to expect things rather instantly — even their health care. However, personally, I would rather wait for a 5-course meal to be cooked, rather than eat McDonald's.

The wife of a patient in our emergency department didn't see it that way. She brought in her husband (of her own volition) to be evaluated for chest and abdominal pain that he had been experiencing for the past few days. After 5 hours in the ER, she became quite irate, and starting verballing harassing staff members to the point where we needed to call Security. Had her husband been sitting in a room for 5 hours without evaluation (which has happened when the ED is busy), I might have slightly understood. This was not the case — in that time her husband had been evaluated by an ER MD, received 2 EKG's, a complete laboratory workup, (including a second set of cardiac enzymes which need to be drawn 2 hours after the first set), a spiral chest CT scan, an abdominal CT scan, (for which the patient must drink CT dye over the course of 2.5-3 hours), and evaluations from two specialists - a cardiologist, and a gastroenterologist.

Sorry, but if you want this complete of an examination it will take a number of hours - no drive-through diagnosis here.

Well, at the ambulance and so far so good — 7 hours without any calls, and only 5 to go. Off to sleep now so I can be nice and refreshed for my 12 hour ED shift tomorrow.

Today's ambulance shift wasn't too busy, 7 calls between two crews in 12 hours. (However, the average call takes 1.5-2 hours to complete, depending on hospital.) I was the driver of the BLS crew today, and somehow we did 4 calls, and the ALS crew only did 3. In an agency rather agressive with its ALS, that's unusual.

Our first call of the day was a 45 year old man who was working in a paper mill, stepping where he shouldn't have been, and subsequently got his foot caught under a 700lb steel cylinder. While this call had the potential to be bad, when we got there, his foot was already out of the machine. His foot/ankle was very painful when touched, swollen and bruised, but no bones sticking out or other gross obvious deformity. After splinting, he was treated to a ride to the Level 1 Trauma Center, simply because on top of the probability of fracture, he was also complaining of some symptoms of compartment syndrome.

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Well now I guess we know the educational level of Nascar fans…

EBay - $125 Wal*Mart Gift Card… Final bid $127.51

"nascarfan82088 is the winner" — Winner? How about dope that can't compare 2 numbers to see which one is bigger and which one is smaller…

And we let these people vote…

I have 6 Gmail invites… is there anyone out there that wants one that still doesn't have one?

Comment on this post with name/email, and it's on its way!

After trying SpamKarma for a few days, I have found a few bugs in it (it's still in Alpha)… It'll be a great plugin when everything gets worked out, but it was sending me email for each comment spam it deleted to the tune of a few hundred a day. Some were quite humorous, but still… Since that was what I wanted to avoid, I am now trying out a new comment spam deterrent: ImageAuth. Basically, in order to prove that you're a human and not a spam bot, you need to enter a code embedded in an image (not readable to web bots) in order to post. If you have any problems/comments on this new system, please let me know.

Note: If you get an error after entering an invalid code, please refresh for a new code and a new chance

Happy Thanksgiving everyone! My family is spread all over the world, I am thankful that they are all doing ok. Since I have absolutely no need (or skill) to cook a 16 pound turkey for me and my cat, I donated the free bird that my hospital gives to all employees each year. Instead, I am going over to a friend's house for Thanksgiving dinner with them around noon. After that, it's off to work for the evening shift. It's holiday pay, and usually it is not too busy until after dinner, when everyone comes in with complaints of abdominal pain… Overindulgence, anyone?

What do you think that icon on the electrically powered cheese grater to the right stands for? Ok, I won't keep you wondering- evidently it stands for do not put your hand into this feed chute, especially when the grater is still turned on. My only patient on last night's EMS shift failed to recognize this obviously ambiguous symbol.

He earned himself a trip to the regional trauma center for his efforts. Digits 1, 2, and 5 were mostly unaffected, save a small superficial laceration (cut.) Digits 3 and 4 (middle and ring fingers) got the brunt of the rotating studded metal drum, and the soft tissue (skin, fat, muscles, tendons, blood vessels, etc) were for lack of a better word, mushed. The bones looked to be intact and not fractured. Amazingly distal PMS (no not what you think - stands for Pulse, Motor, Sensation… More politically correct is CMS, but that wouldn't be any fun, would it? ) was all intact with minimal defecit. Bleeding was controlled by a gauze pressure dressing and elevation. Hopefully the local hand specialists were able to take care of it, and he didn't have to go down to the state hand center for microsurgery.

Last night's EMS shift was mostly uneventful… Only 1 call for an elderly female complaing of shortness of breath. SpO2 (a measure of how oxygenated the blood is) was 100% on her home oxygen. Can't really get much better than that, and no signs of acute difficulty breathing, but she demanded transport to the hospital anyways. She had just been released 2 days prior, and had been complaining of SOB since then, so most likely she was in the same condition as when the doctors discharged her. The patient had end-stage congestive heart failure, chronic obstructive pulmonary disease, bronchitis and emphysema… Really not much you are going to do for that, since it's all chronic, and wasn't acute at this time… But anyways, as for the title of this post, evidently a paramedic was assaulted at this address by the patient's son, when the paramedic didn't give his father morphine, simply because he requested it. Wish I knew that before I showed up to the scene all by myself :-/

Hopefully tonight's shift will be a bit more interesting… Now it's off to go eat some lunch, since I don't want to become like the average American family and throw out food… Well that would be mostly due to the fact that I am never home anyways…

I just installed the Spam Karma plugin for WordPress, in an attempt to cut down on the hundreds of spam comments that I had to moderate each day. Comments that look really like spam are automatically deleted, and comments that look suspicous are given a second chance by having the user fill out an image verification, or by verifying an email. Those logged in to a "Friend's Only" account are automatically approved. If you have any problems with this new system, please let me know.

Update:

Seems to be working well and automatically deleting spam, despite spammers trying to make their ads look like real comments by adding text between the links for porn, online casinos and cheap pharmaceuticals. Among the pearls:

• Sex-appeal is the keynote of our whole civilisation.
• Government has no other end but the preservation of property.
• No philosophy, no religion, has ever brought so glad a message to the world as this good news of Atheism.
• Nobody before the Pythagoreans had thought that mathematical relations held the secret of the universe. Twenty-five centuries later, Europe is still blessed and cursed with their heritage. To non-European civilizations, the idea that numbers are the key to both wisdom and power, seems never to have occurred.
• Conceit, arrogance, and egotism are the essentials of patriotism.
• Every man takes the limits of his own field of vision for the limits of the world.
• Scientific knowledge, even in the most modest persons, has mingled with it a something which partakes of insolence. Absolute, peremptory facts are bullies.
• In the strict sense of the term, a true democracy has never existed, and will never exist. It is against natural order that the great number should govern and that the few should be governed.

Last night I was "mandated" (i.e. begged) to stay at work for an extra 8 hours to man the Triage desk, since a nurse called in sick. For those of you who don't know, Triage is where patients who want to be seen by a doctor in the Emergency Department show up, and get their history/vitals taken in an attempt to prioritize who will get seen first. Last night was, thankfully, an unusually slow night, and only a few times did I have multiple patients show up to the window all at the same time.

Now I usually complain when stupid people call an ambulance for some non-emergent problem. This time, it's the stupid people that didn't take an ambulance. Like the 20-year-old male who had 2 seizures in one day, but had never had them before in his life. A couple of hours after his last seizure he decided to drive himself to the ER. Now if it were me, I would be calling an ambulance at the first seizure… Imagine what would have happened if he had experienced a siezure while driving - he could have killed himself or someone else.

And then there are the just plain stupid people. Like the 18-year-old female that said she thinks she smoked pot laced with "something" a month ago, and since then was complaining of shortness of breath, chest pain, nausea, vomitting, and occasional loss of consciousness. It took you a month to get this checked out? Similarly, a 28-year-old female complaining of abdominal pain. The patient was pregnant, but 2 months ago had an episode of severe vaginal bleeding, and thought she might have mis-carried. So you may have been walking around with a dead fetus in your uterus for 2 months? No wonder you have abdominal pain. Some people just amaze me.

Well after sleeping through the only call on the ambulance last night (it was some 2-Alpha non-emergency that the rest of the crew took), it's back to work today, and then back to the ambulance tonight.