Typical Evening in the Emergency Department

Written by Tad. Posted in Kooks

When I tell people I work in the emergency department, they usually think first of taking care of injuries. Trauma is only a small part of what I do. One night, I printed out the ED census, listing all the patients in our ED at that time. Here is a review of that list which gives you a good idea of what is going on in my life when I am at work. It was about 6:30 PM. Here is a list of the patients and what was going on with them at the time.

62-year-old lady with chest pain. It is very difficult to get her history. Multiple blood tests were sent to the lab. Her potassium came back hemolyzed so it had to be redrawn and resent. We are waiting for that at this time. I am considering whether she needs admission.

22-year-old sent here by clinic doctor with high suspicion of pulmonary embolus (blood clot in the lung.) Multiple blood tests were sent to the lab. She is in CAT scan at this time. She will probably need to be admitted for anticoagulation.

54-year-old lady with chest pain. It is very difficult to get her present and past history. Multiple lab tests, EKG and chest x-ray have been ordered. I am planning on admission.

73-year-old lady from nursing home with possible seizure and cyanosis. She has had no history of either in past. I had to call the nursing home for more information from the nurse there about what happened there. I then interviewed her son when he showed up. Her x-ray shows a pneumonia. I am considering admission for pneumonia with cyanotic episode. Her CAT scan is pending at this time.

34-year-old lady with large abscess on her abdominal wall from shooting drugs. The physician assistant didn’t feel comfortable she could adequately drain it. The patient has been given multiple doses of intravenous narcotics until she could be comfortable enough for me to finish draining and packing it. She will probably be able to go home.

30-year-old lady who was in a car crash. She is very upset and complaining of neck pain among other pains. It took almost an hour to get her registered so neck x-rays could be taken. She is in X-ray now.  Her emotional situation and delays in getting her registered required me to visit the bedside multiple times. She will probably be able to go home, assuming her x-rays are normal.

31-year-old lady who passed out and has chest pains. After chest x-ray, EKG, labs and reevaluation, I considered work up for pulmonary embolus but she is being discharged.

57-year-old man with chest pain and numbness of his legs. He has complicated present and past histories. I had to review his labs, x-rays and old chart. I had to medicate him to get him out of pain. He has been admitted.

14-year-old girl came in as a trauma alert from a car crash. Her x-rays and a reevaluation are pending. She probably will be able to go home.

22-year-old man with infection of operative sight. He has had lab tests and a surgical consult with consideration for readmission.

61-year-old man with chest pain. He got an EKG, x-ray, and blood tests and has been admitted. We are waiting for him to be assigned a bed so he can go upstairs.

74-year-old man with head and neck pain. He is getting a CAT scan and lab tests.

42-year-old lady with pains from car crash. She is the mother of the 14-year-old. She will be discharged when her daughter is ready to go.

33-year-old lady with very complicated present history of headaches, chest pains, vomiting and numbness like what she had with her stroke. It is very difficult to get the history. She had multiple labs, EKG, chest x-ray, CAT scan of her head and extensive review of her old chart. She is admitted.

40-year-old lady with vaginal bleeding and feared pregnancy. She will be discharged if her pregnancy test is negative. Will need a pelvic ultrasound and obstetrics consult if it is positive.

72-year-old man visiting from the Philippines with multiple complaints arising from not getting adequate care for his hypertension and diabetes. He had multiple labs, EKG, chest x-ray and ultrasound of his leg. He is admitted.

53-year-old lady with atrial fibrillation (irregular pulse) with a pulse rate of 180. She has a complicated history. She had multiple labs, EKG and a chest x-ray. She required multiple doses of multiple drugs in an unsuccessful attempt to control her heart rate. I talked with intensive care resident as we considered putting her in Intensive Care. Her pulse is now controlled enough that she will be admitted but not to ICU.

62-year-old lady with chest pains after a car crash. She is getting x-rays and labs. She may need a CAT scan and a trauma consult depending on the results.

43-year-old lady with severe allergic reaction. She is being observed after having been given intravenous drugs.

32-year-old man with abdominal pain. Laboratory tests and surgery consult were obtained. He is admitted to the operating room to have an appendectomy.

52-year-old lady admitted with weakness and shakes from alcohol withdrawal. Multiple lab tests were done and intravenous drugs were given to control her symptoms. Her disposition will depend on lab tests results and how she responds to treatment.

50-year-old man came in by ambulance after injuries from an altercation. He just arrived and has not been seen yet.

24-year-old lady with pelvic and abdominal pain worrisome for pelvic inflammatory disease. Her lab tests are pending. She may need a pelvic ultrasound and a gynecology consult depending on the results of her tests.

75-year-old man with head and neck pain. He just arrived and has not been seen yet.

Swallowers

Written by Tad. Posted in Kooks

We have a couple of swallowers who are frequenting our ED recently. One is in the inpatient psychiatric unit at our hospital. The other is in a closed psychiatric facility in the community. They both are very crazy and act out by swallowing anything and everything they can get a hold of. This usually leads to them coming to the ED for evaluation. Sometimes we just send them back to let the swallowed item pass. At other times we have to arrange to have someone go in after it, depending on what it is and how far down it got.

The lady in our hospital is under one-on-one observation. At her side at all times is a sitter whose job it is to keep her from swallowing anything. The other night, the patient leapt onto the sitter, pulled a pen out of her hand and gulped it down. Of course, they called and sent her to the ED for evaluation. I got an x-ray to see if had passed all the way into the stomach or if it was still in the esophagus.
The pen was mostly made of plastic, which doesn’t show up on x-ray. The only evidence of its presence was the little metal part at the tip that holds the ball in place. It was in her esophagus and showed that the pen had been swallowed back end first and was about half way down. I called the gastroenterologist and arranged for them to see her first thing in the morning.

I told the patient she was going back to her inpatient ward and she got really upset. As soon as I turned to go back to my paperwork, she leapt out of the gurney, bolted to the nursing IV cart, opened a drawer, grabbed two hands full of items out of the cart and was just about to get them to her mouth when she was stopped and restrained. She went back to psych hollering and screaming.

 

Copyright © 2014 Bad Tad, MD