Tuesday, February 09, 2010

Pay Attention

I have seen a few tricks deployed to 'jump the queue' in the ED. Last night's took the biscotti. A patient old enough to know better presented heavily inebriated, having turned their ankle. Quick exam off the Ambulance trolley suggested a bad sprain, but probably a fracture. There was swelling, for sure, but no neurovascular embarrassment, and he beer jacket was providing adequate analgesia.

The Department was kicking, heaving, alive with criticals, and sicker people needing trolleys. She would have to wait, and we apologised for this, and left her in a chair.

She muled this over for a while, and took maters into her own hand. She levered herself out of the chair, took a step, tottered for a second, and before we could reach her, turned her ankle again.

Through 90 degrees.

What had seemed a simple injury suddenly became very complex, and her foot turned white. Our efforts to restore anatomy and circulation were hampered by the patient's state of mind.

I'm not sure where she thought she was, but was incapable of grasping the (relatively) simple concept that she was in hospital, and had a (now) badly dislocated ankle.

She fought us every step of the way, and we had to settle for a half baked job, afraid as we were of over sedating her and adding aspiration to her growing list of injuries. We managed to go from dislocated to subluxed, from white and cold to purple and warm, pulses restored if anatomy stubbornly remaining abnormal.

She at leas got seen quickly, even if she never walks quite the same way again.

1 comment:

Chrysalis Angel said...

Oh, that's going to hurt when other things wear off.