Saturday, April 05, 2008

Whirly Whorl

Grumpy Bastard alert.

L'il Shroom's irritability levels have been tripping off the scale of late. Full Tilt Kozmic Boogie, you might say, if ye were that way inclined.


Dunno, but I am eternally glad that my colleagues at work are prepared to put up with me. I was especially annoyed this evening with a work colleague, who, it seemed to me was showing scant regard for the fact that I was already an hour late leaving; I have at least enough insight to realise that this was unlikely to be an intentional slight, and that I am attributing altogether too much import to myself, and my own self worth, but it stung nonetheless. What hurts the most is the way that we sometimes get taken forgranted; but I am loathe to foster an "Us and Them" relationship. In any close relationship, the partners are bound to rub each other up the wrong way from time to time, and what should mark me out as (mostly) different from the chimps is how one reacts.

Especially when one is a hypersensitive, moody bugger like me.

Anyway, was grumpy, have ranted, proved to have no grasp of modern verse. Feel better now.

An unusual week for ill folks. The young lady with Boerhaave's is still going on ITU. I went to see her. I felt I owed her. At the very least, I felt I owed her husband; I found I could look him in the eye, and, perhaps more to the point, he could look me in the eye. So, now we wait mediastinitis. My prayers are all I can offer her now. We'll know soon enough.

Next: a man with more than his fair share of rib fractures.

Run over; including, if you can believe it, his head. Initially, very uncomfortable (no, really?) Morphia saw to that, and we mostly goggled at him, thinking how lucky he probably was. Then, we spotted part of his chest moving the wrong way. For the non medical, what I mean is that, for every breath he took, most of his chest moved up and out, as per guidelines. But, some of his left chest resolutely declined that option. And moved in; as if it were being sucked in.Which it mostly was. During normal respiration, the diaphragm flattens and pulls down, while the ribs are pulled up and out by the intercostal muscles (between the ribs). This increases the volume of the chest cavity, lowering pressure therein and encouraging air to move in an 'into the lungs' kinda way.

But, if you disconnect a section, by, say, fracturing several ribs in two places, that section moves with the pressure - so, decrease pressure in the chest, chest wall sucks in.

As well as painful, this is bad for the whole process of respiration. In fact, it's number one on my list of 'Unfavourable Chest Wall Injuries'.

It certainly did nothing for his mood.

But... morphine.

Part of the treatment involves placing a large bore plastic tube between the ribs, so decompress the inevitable pneumothorax, and improve respiration. Not easy at the best of times, it's even harder when the chest is not as... connected as it should be.

So... fentanyl.

When I left, he was remarkably chipper, and gave me a big thumbs up. Well worth it.

Today: forehead versus horse. No contest really, although it did give me ample opportunity to flail, flail and flail again trying to garner assistance in transfer to the Mighty Donut. The injury put into perspective all the times I've palpated a scalp, wondering if I was feeling a step off, fortelling the presence of a depressed fracture. This wasn't subtle. It screamed 'behold! Here I am! The indentation produced by a rapidly moving horses hoof'.

CT showed a fracture through frontal bone and sinus, which, relatively speaking, ain't so bad. She was definitively concussed however, continually identifying her location as such esoteric locations as 'the kitchen', 'Sainsbury's', 'the garden'... anywhere but the hospital really. But she'll be fine, although I can't help but feel it might be a while before she makes any sense.

On a lighter note, I'd like you to consider how you might mime the Horse attack. We theorised that men do it one way, and women another, if at all. Think on it, and let me know, if ye can be bothered.


Chrysalis Angel said...

It isn't always the one we "think" we want that whisks us away. Good luck with the new and improved lassie! :)

the little medic said...

I seriously misread that last line!

Glad your oesophageal tear lady is still going.

Lab Rat said...

hey, question. can you photoshop a copy of that CXR to show all the fractures? I'm curious to see if I found them all...

DrShroom said...

i'm sure it can be done... not ure if i can do it. Looking at the original again today, he's deffo done ribs 1 - 8, clavicle and scapula; I kinda stopped countin after that