Subaqua Sternal Rubs

Last night's ambulance shift was actually pretty quiet. Only one call, which can be blamed on one of our members in the EMT class, who was wishing for a call. The patient was a 76 year old woman who was just released from the hospital yesterday with a pneumonia. Evidently they had used her dialysis shunt improperly, and now it had been bleeding at a relatively steady rate for the past 4 hours. Upon arrival, she was sitting in a chair in the bathroom, with her arm wrapped up in a chux pad. Initial blood pressure and pulse were relatively normal, 110/72 and 76. Once we got her in the ambulance, we removed the chux pad to find a large amount of blood with clots. The arm was re-wrapped with 5 4×4's and 4 rolls of 3″ kling. Using pressure and elevation controlled the bleeding pretty much until the hospital, when it started flowing through all the gauze, much to the dismay of the nurse and the housekeeping staff that needed to clean up the trail of blood we left in the hallway.

Yesterday's Emergency Department shift was equally uneventful. I, once again, was posted in Team 4 aka Sub-Acute for people coming to the ED with low-acuity/non-emergencies. I think I only saw 9-10 patients in my 6 hour shift. Most were rather mundane, except for the gentleman who came in stating that he had a "medical background," diagnosed that his son had torn a meniscus in the knee, and was demanding an MRI. I told him without an MD behind his name, he could not start ordering anything. I also told him that I could send him over for x-rays, but he would have to wait for the doctor to order the MRI. (Which wasn't likely to happen anyway - I think I have seen 1 MRI done from the ER in my 7 years there.) So he called his son's orthopedist, who he had seen multiple times, and got an appointment for about an hour and a half after he arrived in the ER. The orthopedist told him to get the x-ray, (Hmm, what did I say?), and the father demanded it be done instantly, but sorry, for a non-emergent condition like knee pain (compared to people that actually may die of their illness/injury), that's simply not going to happen. As it turned out, one of the x-ray rooms was flooded and the x-ray machine in another room was on fire. Needless to say, x-rays weren't happening for a while, so the patient and his father went straight to the orthopedist, which is what he should have done in the first place. If it took me 2 weeks to get my insurance company to approve an MRI after initially denying it, what makes this guy think he is any different? Unfortunately in the ER, you can't have it your way - since we need to balance the emergent needs of those critically ill/injured with those less so. (And for some reason, it's always the patients with the non-emergent problems that make the most noise that they are not being taken care of quickly enough.) You can read about my thoughts on this matter in a previous post.

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