Monday, June 18, 2007

New record

This week I broke one of my records without even realizing it until I did some calculations this evening—I worked at the hospital 98 hours this week, shattering my previous record of 90 attained on CT surgery last year. I had to add it up several times before I believed it—100 hour work weeks are much more doable than I ever thought possible.

I have seen so many traumas this week that they have started to run together in my head. The most dramatic was a man who was brought in unconscious after a gun shot wound—we did a rapid assessment, then rushed him to the OR. We cracked his chest as he lost his pulse—I did chest compressions for about five minutes while the surgeons attempted to control his bleeding (he had lost almost two liters of blood from his chest before we got him to the OR, and was rapidly losing more). They found the artery, but it was too late and he died on the table, a sharp contrast to the man last week who lived.

The most memorable was at about 10:00pm when we got the page: “man fallen on by cow”. He was unconscious when he came to us so we weren’t able to get the full story. Amazingly all he had were a couple of cracked ribs, and he woke up the next day, and went home the next. I was able to get the story before he left: apparently a cow had bumped him and made him trip over a feeder, another cow then ran into the first and it tripped over the feeder onto the man’s chest—he is very fortunate to have escaped with such minor injuries.

One nice thing about level one trauma centers is that they tend to be very organized, and they operate on a protocol. When the patient is brought into the ER by the paramedics, he is immediately transferred to the hospital gurney, then the paramedics remove their gurney. The patient is surrounded by an number of doctors and nurses, the doctors are residents from either ER or surgery depending on the week. The captain stands at the foot of the bed and directs everyone. Doc Right stands on the right and performs the physical exam, starting with ensuring adequate breathing and pulses and then moving to less vital areas. The head doctor stands at the head and controls the airway, intubating if necessary. Doc Left (usually a medical student) stands at the left and cuts off all clothing as soon as the patient arrives to expose any hidden injuries. If the patient is rolled away from him while removing the backboard he also checks the back and does the rectal exam. Later, he draws blood from the femoral artery and places the foley catheter if necessary. The attending surgeon stands in the back of the room and makes sure no one screws up. For each doctor there is a nurse who gets vitals, obtains IV access, and performs other duties. If the patient is stable he is then taken to the CT scanner. Depending on what is wrong, he either goes back to the ER, to the ICU, or to the OR.

My last call night I saw the call rooms (room with a bed, desk, and telephone for residents/students to sleep in during down times) for the first time this rotation. Around 1:00 AM I went to bed, but unfortunately it was just a tease—ten minutes later as I was just in the transition zone between sleep and wakefulness another trauma came in. An hour later I went back to bed, and this time managed to fall asleep and stay asleep for 45 minutes before being rudely awakened by (one of the three that I carry on this rotation) pager. When I called back, it was the ER who had a man with a large perineal abscess—why he felt the need to come in at 3:00 in the morning instead of the next day I do not know, but I was pretty annoyed. I went to see him, then paged my poor intern, waking him up as well. It turned out all right though, because three minutes later we got another trauma so we would all have had to have gotten up anyway. This trauma was an assault victim. Five minutes later we got another assault victim. It turns out the first had tried to stick up a bunch of people, and had gotten beaten up for his trouble. The second was one of the people being stuck up who fought back. Fortunately we only admitted one to our service so we did not need to have police guards at both rooms to keep them apart.


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