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Such Is Life

June 26th, 2009 by scanman in Better Health Network, True Stories
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I was called to do an urgent bedside ultrasound scan of the abdomen for a trauma victim.

The patient was a young man of twenty-four who had been involved in a road traffic accident (RTA = MVA in US medical terminology). He had been brought – without any kind of basic life support – after sustaining a major trauma at a village about two hours away. The intensivist in the ICU told me that he was in severe hypovolemic shock on admission with a GCS of 4. Preliminary examination and radiographs had shown a comminuted fracture of the right femur (thigh bone) with a large hematoma and some facial bone fractures. After initial assessment and resuscitation in the casualty, a CT scan was done. He had a fracture in the frontal bone and a few small contusions in the brain, that raised the possibility of Diffuse Axonal Injury, nothing that could explain a GCS of 4 though. The assumption was that it was all due to extensive blood loss and hypovolemia. He was shifted straight to the ICU after the CT scan and I was called to do an ultrasound scan to check for hemoperitoneum (ie, abdominal injury and blood loss).

The scan was normal. As I was doing the scan, the intensivist was busy trying to put in a Subclavian central line. He secured the line just as I finished my scan, which incidentally was normal. As I was stepping away from the bed, the patient had a cardiac arrest, as evidenced by sudden bradycardia on the monitor. I moved out of the way as the intensivist, orthopaedic surgeon and ICU nurses went through a full resuscitation protocol. After a while, even I realized that it seemed like a futile exercise.

I was not particularly busy, so I peeped into to the Cardiac ICU next door as there seemed to be some commotion there. My cardiologist colleague, a normally friendly soul was peering intently at a very fast heart rhythm on a monitor over the bed of a young girl of about six or seven. There were a couple of nurses injecting something slowly into an intravenous cannula in the kid’s forearm.  In passing, I noted that the kid was very calm and seemed very interested in what the nurse was doing. I stepped close to my friend and asked what was up. He turned, gave me a quick nervous smile and said he was trying to revert an SVT (supraventricular tachycardia, a very nasty fast heart rhythm). Honestly, I had never seen an SVT in someone so young, so I asked him what was the history. He told me the kid was brought by her mother to his outpatient clinic a short while ago because she complained of palpitations (I forgot the exact description used by the kid, but it was quite descriptive). My friend said he was sure it was an SVT after a quick examination in the clinic, so he rushed the kid upstairs to the Cardiac ICU, connected her to a monitor, confirmed the diagnosis and had ordered Adenosine IV stat for reversal. He maintained his intent survey of the monitor as he recounted the story and the nurse continued her slow IV injection. At one particular point when the line on the monitor became particularly squiggly, he shouted, “STOP!” and the nurse stopped injecting.

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It was almost magical.

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The squiggles became a recognizable cardiac rhythm, albeit very fast – about 160 to 170 beats per minute. My friend called out to one of the superfluous nursing attendants and asked them to get the kid’s mother inside. A very anxious young lady who had obviously been weeping was led in. My friend showed her the monitor and explained to her that the nasty rhythm had been made to behave itself or something to that effect and told her that the kid was out of any imminent danger.

Happy with the positive outcome, I strolled out to be confronted by a wailing family, including two young girls, maybe a year or two older than the calm kid inside, who had just been told that their older brother who fell off his motorbike was dead.

It was past my work hours. I went out and had a drink and reflected.

Such is life.

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*This blog post was originally published at scan man's notes*

Iranian Doctors and Nurses Speak For the Dead

June 22nd, 2009 by MotherJonesRN in Better Health Network
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Like most of you, I’m continuing to watch the events unfold in Iran via Twitter and YouTube. Not surprisingly, given the escalating violence, doctors and nurses are caught in the crossfire. This video was posted on YouTube on June 16th. One woman who I’m guessing is a nurse is showing a sign that says that 8 people were martyred. Toward the end of the clip the young man (whose voice breaks down many times) is saying that he witnessed the brutal beating of women and children. He speculates that the attackers were Lebanese Hezbollah. Hat tip to Andrew Sullivan, The Daily Dish.

This story really upset me because I work with medical students at UGH (Undisclosed Government Hospital), and because I have children who are the same age as these victims. The eye witnesses reports come from medical students who hid when Iranian militia and police raided a Tehran University dormitory in the middle of the night. Hat tip to Nico Pitney of the Huffington Post. As we witness history, we will continue to witness the murder of innocent people.

(From the Huffington Post)

“At the same time, Iran’s Interior Ministry ordered a probe into an attack late Sunday night on Tehran University students in a dormitory reported to have left several students dead and many more injured or arrested. Students say it was carried out by Islamic militia and police. Iran’s English-language Press TV said the ministry urged Tehran’s governor’s office to identify those involved. Iran’s influential speaker of parliament, Ali Larijani, condemned the attack.

Students’ Web sites reported mass resignations by Tehran University professors outraged over the incident. One medical student said he and his roommate blocked their door with furniture and hid in the closet when they heard the militia’s motorcycles approaching. He heard the militia breaking down doors, and then screams of anguish as students were dragged from their beds and beaten violently.

When he came out after the militia had left, friends and classmates lay unconscious in dorm rooms and hallways, many with chest wounds from being stabbed or bloody faces from blows to their heads, he said. The staff of the hospital where the wounded students were taken, Hazrat Rasoul Hospital, was so shocked that they went on strike for two hours, standing silently outside the gate in their white medical uniforms.”

*This blog post was originally published at Nurse Ratched's Place*

It’s not what you say – or even how you say it

April 29th, 2009 by Stacy Stryer, M.D. in Uncategorized
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Yesterday I was sure that I wasn’t going to talk “swine.”  Twelve hours ago I had almost, definitely decided on my topic.  And it wasn’t swine flu.  But sometime between then an hour ago, I changed my mind.  I’m allowed to do that.  It’s my blog.  And, guess what.  I changed it again.
I actually began to write about the swine flu but then took a break – for a very important reason.  My sister, daughter and I had to start decorating hats for friends and family members who will join us this weekend to participate in the brain tumor walk in Washington D.C.  Each year we form a team in memory of my husband, who died 4 years ago.  As I was about to start writing my “swine” blog again, a friend and fellow team member emailed me to make sure that I pick up a “yellow” shirt for her tomorrow instead of a white one (when I pick up team members’ shirts for them), indicating that she is a brain tumor survivor.
This weekend always marks the beginning of two weeks of intense emotions.  It begins with the brain tumor walk, moves onto the anniversary of my husband’s death in the Jewish calendar, then his birthday and, the day after that, the anniversary of his death in the common calendar.
This weekend also serves as a reminder of how important friends and family are. Each year I am amazed by the number of people who join me to celebrate my late-husband’s life and to support our family.  While my children have to carry the burden of their father’s death, they also have learned how important life is and how lucky they are that so many people care about them.
It is difficult to know what to say when somebody becomes terminally ill or when a family member dies.  What are the proper words?  For the most part, it is not the exact words that matter.   What does matter is that friends and family are there to show support.  Immediately – and a week later.  And 6 months later.  And 2 and even 4 years later.
Some of my friends began to check on my weekly after my husband died and, to this day, still check on me the same day of every week.  Others called me recently after a religious leader in my synagogue was diagnosed with the same type of tumor my husband had – because they wanted  to make sure I was doing OK.  Likewise, my daughters’ friends, who are now 5th graders, watch out for her.  When a classmate’s father recently died, it upset my daughter greatly.  That evening  I received several phone calls from her friends’ parents, who had heard she was very sad.  I also received a phone call from her guidance counselor, letting me know about the death and making sure my daughter was OK.
We have over 65 people walking with us this Sunday.  Our team is comprised of aunts, uncles, in-laws, and cousins.  It also include teachers, a principal, and an old patient of mine.  Plus, there are friends of my husband’s, good friends of mine who barely or never knew him and, of course, old and new friends of both of my daughters.  Some didn’t even know my daughters when their dad was alive.
I will keep my fingers crossed that most of the people walking this Sunday are accompanied by someone wearing a yellow shirt, rather than just a sea of white.

ER Physician Dies In His Own ER

January 13th, 2009 by Dr. Val Jones in News
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This is one of the saddest stories I’ve read in a while. H/t to GruntDoc.

Dr. Michael Sanchez, who in a few months as director of University Hospital’s busy emergency department slashed waiting times and reduced the number of patients turned away because of overcrowding, was struck and killed while jogging Sunday afternoon.

His own emergency department colleagues tried to save Sanchez without recognizing him because of the extent of his injuries. Only after he was pronounced dead did they learn it was Sanchez, hospital staff said.

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Police said Sanchez was struck in the 11600 block of Bandera Road about 1:40 p.m. Sunday. The driver told police he was on his way to get the brakes on his SUV fixed when his cell phone rang. As he answered it, he said he spotted Sanchez on the side.

According to a police report, Smith said he hit the brakes and the car swerved onto the shoulder, striking Sanchez and sending him onto the hood of the car.

A witness said the driver swerved across two lanes before striking the victim. Police said no charges have been filed.

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Rufe said Sanchez had so much enthusiasm and energy for the job, it made some of his colleagues skeptical about him. But it was that drive that allowed him to push the department beyond the way things had traditionally been done.

“He was telling me one day, ‘I love my job. I love what I do. I love my family. We have a wonderful home. I can’t ask for anything else. And now the possibility of a residency program. I’m just a fortunate person,’” Rufe said.