3 Vignettes from this weekend

8 Sep

Here’s the two calls – well, I’ll tell you 3 of them…because they were really interesting to me…

First one: Thursday night around 2130. Get a call for a 27yof who’s having breathing problems. Usually these end up being low income / morbidly obese women having a ‘drama alert’. This one was different. Well spoken, polite woman who was breathing really fast – just couldn’t catch her breath and sharp pain upon inspiration (breathing in) in her left ribcage, right at her bra strap. Turns out she was having ST Elevation (http://en.wikipedia.org/wiki/ST_elevation) basically a heart attack. Turns out, she’s Muslim (I swear this is relevant…I don’t usually ask what religion, if any, does my patient follow) but I’d asked her what the last thing she had to eat or drink was – and that’s when she told me that she is Muslim and was fasting for Ramadan and all she’d had to consume the entire day was water. So her electrolytes were all sorts of imbalanced and that’s what was producing this ST elevation. Pretty interesting, huh? Gave her 4 baby aspirin, and nitro but no relief from the pain.

These next two were on Saturday.
1300ish – get called to a townhouse by PD because of a domestic. I found my patient (32 yof) lying on her stomach with her head turned to the left. She said that her husband had punched her in the stomach and then stepped repeatedly on her chest. I did the full assessment (which is usual for me and my partner to switch it up when there is a female victim – either domestic or rape – if I do the assessment, the patient is usually more comfortable and more forthcoming) so I do a full visual (noted no bruising, swelling, abrasions NOTHING on her back, abdomen or chest. No markings of any kind) assessment and I followed that up with a palpation (or touch) assessment – which is in my protocols. Again, noted nothing significant. So we backboard, c-collar and put her on the stretcher and take her to the hospital. She’s going on and on about the pain. Now, not to sound TOO jaded, but this isn’t my first domestic violence call and usually the more people who show up to a call, the more pain the patient says that they are in and more violent the assault.

So I turn her over to the ER RN and go about my business. I come back a couple hours later with the patient who’s story I’ll tell you about below and the nurse pulls me aside, and asks if I was the one who brought in the domestic. I said yes, what’s up? She said that the patient was rushed to our Level I Trauma Center because the patient had torn her aorta and was bleeding into her abdomen and was in VERY real danger of dying. The nurse said that she gave 2 of Dilaudid (http://en.wikipedia.org/wiki/Dilaudid) and 4 of morphine and that didn’t cut the patient’s pain. That’s A LOT of pain meds. But still, it wasn’t until the abdominal ultrasound was the aorta tear noted. The patient’s BP was stable, heart rate stable – NOTHING that is usually indicative of bad stuff going on.

1620ish – get a call to a residence because a woman hurt her leg 36hrs ago when ‘Rescue dropped her’. We show up for a woman who is morbidly obese (the kind where the muscle atrophies at the arms/legs but the abdominal fat just keeps growing so the center of balance shifts). Apparently the patient got stuck on her bedside commode the day before and when rescue tried to move her from the commode to the bed, she slipped and her leg (the one she doesn’t have much control over anyways) got ‘pinned’ or ‘bent back’ under her. And now it hurts. And she wants to go to the ER. So it took the 3 fire fighters and the three of us off the ambulance to move her from her wheelchair onto the stretcher. She’s dressed in a nightdress and she stinks to high heaven. It’s my turn to be in the back, so me and the trainee climb up in the back and my trainee starts getting vitals and whatnot while I’m talking to her and calling in my report to the closest hospital. We get there and my partner parks the truck and comes around back and opens the doors wide…which is when he realizes that the patient isn’t wearing any underwear. And he’s at eye level.

I give my partner a huge amount of credit because all he said is ‘she needs a blanket. NOW.’ We cover her up and take her into the ER.

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3 Responses to “3 Vignettes from this weekend”

  1. Epijunky September 10, 2009 at 10:55 pm #

    The trainee deserves a gold star. Just saying. 🙂

    As far as the domestic… Wow. Not what I was expecting.

    Just when I think I have a firm grasp on what is happening, karma or life (or whatever it is), throws me.

  2. Lagniappe's Guy September 11, 2009 at 1:27 pm #

    FYI in future abdominal cases, a dissecting aortic anuerism (pre-tear) will often present as a pulsating mass in the left upper quadrant. I found one on a single-car crash driver who was also ETOH one morning and had a hell of a time convincing the arresting officer that he had a serious medical problem that trumped the need to arrest him.

    I’ve never looked at abdominal pain patients quite the same since, even the drama queens and scammers.

    • tswimmwer September 11, 2009 at 2:18 pm #

      Lagniappe’s Guy – That was the most bizarre thing about the call. There was no pulsating mass in ANY quadrant – not the upper left, lower left, no swelling anywhere. I’d experienced a triple-A before but that one presented with rapidly spiking and dropping blood pressures and a tachy pulse.

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