Before I get to the interesting part... last night, after 17:00, my counter of the days elapsed since I started this journal hit 1,111.11.11.11. It was neat. I missed it, though, dammit.
A 65-year-old lady was having a heart attack in one of the small towns surrounding Topeka. They gave her the super clot-buster, TPA, she responded well, and then they life-flighted her to our hospital. By the time that she was settled in the ICU, she was having a headache, and it progressed. About an hour later, I did a CT scan of her head, and it showed multiple intracranial bleeds...
This is one of the hazards or TPA, of course, and everyone is informed of this possible complication before it is given. I've never seen it happen before, though, and I've taken care of a lot of patients who've had TPA, as well as having a couple of doses myself. And this was a very sweet lady... she passed away yesterday afternoon.
Back to last night. When I got there, all was calm. It was nice to walk in and not see panicked people running around... it was an hour before I did my first patient.
Then, about 22:30 I got an order on the printer to x-ray a patients' foot. Darlene, one of the evening techs, and I sauntered down to the ED since we hadn't been called yet to do the patient. We walked into the traumex room as they were bringing a patient in, a young man about 20 years old. He appeared to be having a seizure and there was the ominous smell of burnt flesh in the air...
Most of the information the we got was third-hand... he had been working on a lift on a movie set(?) in Osage county, south of Topeka. His neck had brushed a 14,000 volt line. He had a hole in the right side of his neck 4cm in diameter and probably 3 cm deep.
It was through the muscle, though... he was damned lucky it hadn't burned through one of the major vessels, although it probably would have cauterized it anyway if it would have.
And his hands were pretty much blown apart. He'd been holding onto something metallic that was grounded pretty good... the flesh on his fingers was mostly gone, like each individual cell had superheated and exploded.
The patient was fairly lucid and cooperative and, at the time, not in pain. Before he was flown to the burn center in Wichita, though, he was starting to feel it and was given morphine.
What I had taken for a seizure initially was actually muscle seizures... not neurological... and shock.
There was not much else happening the rest of the night, but I stayed fairly busy. About 06:30 I was called to the ED to xray a shoulder on a 96-year old lady. I was really surprised to find her sitting up, fully dressed (she looked like she was going to church... or something) alert and oriented. Good hearing, and a good sense of humor. Damn, I wish that I could be that well off when I get to be that old... damned unlikely, since I'm usually not that well off now, and my chances of getting to be that old are very slim.
I got up too early last night, and decided to stay up and get some work done. JD and I cut the counter-top and installed the cooktop. No mistakes this time!
More tomorrow...
Last night was interesting, and I didn't have to do much running. But before I talk about last night, I want to bring up an interesting patient from the night before...