My Play Ground, The Emergency Department

I finished up my first week in the emergency medicine. I have seen so many wild cases. I have had 3 gun shot wounds, 2 stabbing, car accidents, trauma, liver failure, drug overdoses, diabetic keto acidosis, drownings and a bunch of seemingly more boring cases. In the ED you get your hands dirty and you get to do lots of procedures. I never know what I am going to see prior to each shift which makes it exciting and never boring. I will try to document some interesting cases over the next few weeks.

My attending shouted across the room and said "will you go see the patient in room 11 and I will take care of room 8". I yelled back "no problem" and quickly made my way to a computer to see if I could see what was waiting for me in room 11. I scanned the computer screen and saw the words spider bite on the screen. "Easy enough" I thought to myself. The patient had been here for 3.5 hours so if it had been too bad or poisonous I am sure we would have already treated the patient. I opened the curtain and saw a large African American male with a baseball cap on backwards and arms covered in gang tattoos. I introduced myself and asked "what brings you here today?" He glanced up and replied "doc I think I got bit by a spider or something and it hurts!"

I looked at his arm where the alleged spider bite was supposed to be and sure enough he had a large bulging bump on his forearm. I began to examine the bump and ask the patient about when, where and how this happened. It did not look like a spider bite to me. It looked more like an abscess and I noticed a "head" in the middle of the bump. I began to ask him all about his medical history and his life to see if I could piece together an explanation. He explained that he never saw or felt a spider bite him. He just assumed by looking at it that it must be a spider bite. He explained that he worked as a barber and as I looked closer at the bump it looked a lot more like folliculitis (infected ingrown hair). It certainly was infected which meant it needed to be opened up an drained and packed. 

I left the room t present the case to my attending physician and get the supplies to fix the abscess. The attending physician poke his head in and looked briefly at the abscess and told me that he agreed with my findings and to "just take care of it". I returned with all the tools and medication to fix it. I injected the lidocaine to numb the area and then made a small incision to avoid any important structures in the arm. The pus began to flow like a river out of the abscess.

As the pus flowed I realized that there were a few small hairs in the middle of the abscess and I cut them out. It looked like the source of the problem. I showed the patient and explained to him the pathology behind  his abscess. 

I nursed as much fluid out as I could and then used forceps to break apart the abscess and proceeded to clean it out completely. The patient could not watch the action and continued to look away. Finally I packed the wound and bandaged it up. He felt a lot better because I had relieved most of the pressure when I cut it open and drained it. 

The patient thanked me and I sent him out. I am not so sure that this was an emergency but we took care of it anyways.