Wednesday, November 07, 2007

Weekends Are Fun. Right? (1)

Friday Night.

Actually, I like working nights. More autonomy, and it feels vaguely romantic to me. It's ok, I have insight. I know this is weird, but I can't help it. There's something about hospitals at night...

The Department is busy when I come on. Not the best sign, but it's do-able. The waiting room is bristling as usual. The world's most aggressive goldfish bowl.

I have resolved to try and let the SHOs run resus tonight. It doesn't quite work out that way.

Resus is packed when I come on. In bay one is a patient waiting to go to the ward. Some have been waiting 9 hours for this privilege. I think she's got a broken femur, and assorted other fractures. In two is wheezy, short of breath. Also waiting on the ward. I forget who was in three.

This strikes me as terrible. It was less than a week go, and already I have forgotten so much. I think maybe it was a kiddie.

A few simple resus cases flow in. Then it starts to clog. At one stage we have 5 acute cases in a 3 bedded resus.

Then the first of the big three:
Young-ish. Attempted hanging. Head injury on being cut down. Agitated.

When he arrives, my worst fears are not confirmed. His airway is patent. No laryngeal fracture that I can appreciate, and although he looks congested in the upper half, I can feel no sub-q emphysema.

(This is air within the skin. It feels a little like Rice Krispies, or bubble wrap. It is indicative of air leaking into the tissue, usually from the lungs. It is high on Shroom's list of Ways I do Not Want My Skin To Feel.)

He is agitated tho'. And de-cerebrating - an abnormal extensor posturing of the limbs. This is, of course, high on Shroom's list of Postures You'd Rather You Weren't Exhibiting.

He has an ugly wound on the back of his head; evidence of where he was dropped. The final indignity, if you will. Cruelty, heaped upon cruelty.

While trying to restrain him safely, we get to play the ED sedation roundabout / roller coaster game. Up and down, round and round she goes... where she stops, nobody knows. Fortunately, I'm a veteran of this game, and we stop just where we need to. Help arrives in the form of a friendly gas-passer, and we send our guy away to a better place. This, at least affords me the opportunity to come over all ER by straddling the trolley to provide manual in-line stabilisation from the bottom end.

The long, dark walk to the scanner, while I make a few unwelcome phone calls, and break a few hearts in the relatives room. I do not feel a better person.

The scans all come back negative, which is only slightly reassuring. Anoxic brain injury can be like the wife-beater's kidney punch, ruining lives without leaving a mark. That will come later.

There briefly follows a surreal period where I and my anaesthetic colleague try to arrange admission for our guy. Ortho and Neurosurg all agree he will need their input; just not right now, so they aren't admitting him. I am disappointed to discover this doesn't really surprise me.

After a brief hair tearing, my Maiden in Shining Armour (she of the Expensive Scares) convinces the Magicians that they should take the patient.

I can't pretend to understand it, but at least we found him a nice warm vent for the night.

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