Emergency Reflections

I have been finished with my recent Emergency Medicine rotation for a couple of weeks now and have not had the opportunity to write much lately. So I thought I would post about a cases I had in the emergency department. I am going to post it in first person story form. 

It was about 1:00 am when a older looking women carried by a man was violently heaving blood into a metal kitchen usually used to cook a Sunday dinner. I glanced up from the chart I was working on and I was nearly blinded by the bright yellow glow exuding from her skin. I have seen jaundice many times but this was a bright yellow and her eyes were also taxi cab yellow. The pot was filled with bright red blood. She continued to purge blood from her innards into the pot and the bright red blood popped against her bright yellow skin. It was actually a beautiful combination of colors, like a modern painting. 

This women is sick, I thought to myself as I helped move her onto the bed in the resuscitation  room. As I looked at the bright colors I quickly ran down the differential diagnosis in my brain. What is wrong with this lady?  I looked her up and down and looked at the man who had carried her here and I assumed that he must be her husband. The yellow skin and eyes was a sure sign of liver involvement. Liver pathology in America often means alcohol. I was quickly cataloging and searching in the file cabinet in my brain for everything I knew about the liver and liver disease. I was flooded with information and experiences that I have gathered over last few years. 

As I questioned the patient and began stabilizing her and talked to her husband the clues began to accumulate. The most helpful and telling clue was the stench of alcohol that filled the air. The nurse was struggling with the IV, she could not get it in and we needed access to the patient's blood. The nurse looked at me and said "doc, can you help me with this?" I wondered if this patient had hepatitis or AIDS. I had gloves on at this point and I grabbed the IV from the nurse and began feeling and looking for a vessel to exploit on the patients arm. It was small but I was confident. I began inserting the IV and all was going smoothly when the patient began surging and I knew what would happen next. I had realized I was in the vein and I did not want to loose this IV so I held on strong as the patient heaved blood all over my arm. My lab coat was speckled with bright red blood. 

I got the IV in......

To be continued.