I had another shift at the community emergency department in the urban setting. This morning I worked early morning until, I guess, kind of early in the evening. A 10 hour shift. I started off the day with the first patient who was an individual who had a head laceration that was bleeding; she lost lots of blood. The scalp has a lot of vessels that feed blood to it, so when the scalp is cut it tends to bleed profusely. This laceration required me to irrigate the wound, clean and explore the wound. I had to make sure there’s no foreign bodies in the wound and then make sure that I could clean the wound and close it properly. This laceration was on the back of the patient's head. I decided to use staples and I put 4 staples in the scalp to close the wound. The patient had fallen and hit her head and had lost quite a bit of blood so we kept her for a while and ran some labs to make sure that she hadn’t bled too much.
I was in the middle of caring for the 1st patient when I got pulled out to run to Resuscitation Room 1 where we had a nursing home patient who was found to be nonresponsive and brought in by paramedics. I got in there and his vital signs looked fairly stable but he was having some difficulty breathing and getting the proper levels of oxygen. So, ultimately, the decision was made by myself and the attending to intubate the patient so I went through the process of getting the proper medications and the equipment ready to intubate the patient so he could be hooked up to a ventilator, which is always a flurry of excitement and commotion. So, fortunately, this was a less difficult intubation for me or, maybe I’m getting better at it or possibly he was just an easier patient. Regardless, I was able to intubate him without any problem and get him hooked up to the ventilator settings. Once he was stable enough, we sent him down for CT, we had noticed while we were examining him that he did have what looked to be like a shunt under his scalp in the skull area. We didn’t have much of a history from the paramedics or the nursing home so like a lot of times we are sort of going on what we can find on the patient and he was nonresponsive so we figured he was having some increased intracranial pressure from something related to a shunt in his head, we sent him down to CT scan. He, in fact, did have a shunt and it did look like to me that his left side lateral ventricle was enlarged but it’s hard to guess because we didn’t have a previous study to look at and compare. Ultimately, this patient went to the ICU. I had to page neurosurgery and explain the details of his case and convince them that this patient was worthy of being seen by them and they came down to the ED and actually saw him in the emergency department, which is often rare so I must have done a good job convincing them to come down.
Neurosurgeons are extraordinarily busy and don’t like to be bothered and can be kind of rude or seemed bothered over the phone but I had all the information that they needed so when I called them they were not annoyed with me and came down. Those were two of the patients that I had today. I could continue on and on and tell you about all 20 of the patients but I’m trying to pick and choose some of the more interesting cases.
I did have a run of the mill kidney stone patients and I also had a patient I diagnosed with or gallbladder disease. I did a bedside ultrasound and found a gallstone in her gallbladder and I admitted her for a cholecystectomy. She’ll probably have the surgery tomorrow. So, anyways, it was a good day, long and tiring day. That’s how the emergency department can be. It’s just a non‑stop, running, running, you never know what’s going to come through the door and I guess, maybe , that’s what I like about it. Anyways, have a good day.
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