TOYS: Christmas Hazards

Working the holidays has it's pros and cons.

On the positive side all the "extra" people are gone (administration, students, JCAHO prep teams, extra visitors). The overhead announcements have quieted. The team that is working seems more relaxed. Family members treat you as those "Angels of Mercy" who sacrifice to take care of their loved one on Christmas and there is always too much food.

On the negative side.... you have to be away from home when it feels like everyone else in the world gets to be with their children, the staffing is pretty thin and if your in the ER...nobody told the public to stay home, not drive drunk and not to get in fist fights with relatives.

And then there are the toys. The least of the recognized holiday dangers. A young Dad limped into the ER holding his side. His story: "I came down stairs and the kids had their toys everywhere. All over the living room, the hallway, the kitchen..everywhere. I told them to pick them up then went back up stairs. When I came down again my son hadn't picked up any of his stuff. I tripped over something and fell onto the coffee table. I think I broke a rib."

An hour later we admitted him to ICU with 3 fx ribs and a torn spleen. He was hemo-dynamically stable but he was in shock at what we had found. He kept shaking his head saying "What were the odds?". In no time at all his children had arrived to be at his bedside with Mom. I felt really bad for the 7 yr old boy hiding in the corner. I knew it was his toys.

CALL A CODE.. For real this time

" I need some help.... I need some help" I heard in a concerned voice down the hall. I exited the room I was in and followed the voice in distress. Upon entering the room the nurse said " he just started saying he was feeling really bad!" The man was sitting upright in his bed, his upper body shaking, eyes half open, and he was not responding to us. We checked for a pulse and he had one and was he breathing as well. I looked out on the monitor and he was in VT Ventricular Tachycardia. We yelled to call a code and grab the code cart. As another nurse arrived with the code cart his face turned purple and he fell back. I said " I'll bag him" , they got me to equipment and I began to breath for him. They hooked him up to the monitor as the code team arrived. The few minutes it took them to arrive felt like an eternity. Soon there were about 20 people in the room eager to help. The doctor ordered 150mg bolus of Amiodarone. They gave it. The man eventually lost his pulse and we shocked him. All of a sudden he was responding and the doctor asked him to hold up 2 fingers. He did. OH MY GOSH! He made it. I was so shocked at how fast he came around. The only codes I had ever seen were in the ER and the mostly got intubated and sent off to the intensive care unit after stabilizing. We sent him off to the coronary care unit as he now qualified for and internal defibrillator. I checked on him on my way out that night and he was doing great. Amazing!
So what happened? The nurse told me she was preparing to pull out his epicardial pacing wires and he started saying " I really don't feel good" and then started looking really bad. The surgeon said when he got the page he thought the man may have been going into cardiac tamponade and was preparing to open up his sternum at the bedside. I am so glad that was not the case. The whole thing ended well and I can say it was quite exciting.

BLACK MAGIC MARKER MISPLACED?

The patient was finely dressed with a southern gentleman's flair about him. Not a hair out of place,...pants perfectly creased. Our ER physician walked into the room and said "How can we help you today"? Without blinking an eye the patient responded straight faced in a long drawn out southern drawl "I hav ah magic mahker in mah rectum and I cahe NOT to answer any moh questions". OK.... the magic marker was removed, no further conversation. The gentleman brushed the wrinkles out of his shirt sleeves and walked out. He left his discharge instructions on the stretcher. Guess those aren't something a man of his stature leaves around.