In the Emergency Department
Working in the Emergency Department of a county hospital, I have had my share of varied and interesting experiences. Some of the situations I see are amusing, but most of my cases are quite sad and heartbreaking. I have been working the night shift for the last few days, and without fail the middle of the night is often the time when the most bizarre cases present to the ED. Here are some cases from last night:
One gentleman came in after getting a huge mag-lite flashlight stuck in his rectum.
He was taken to the Operating Room for removal by the surgery team.
A middle-aged lady with history of multiple sclerosis was brought in by ambulance for vomiting. Her entire body reeked of a foul stench, and she was found covered in her own stool as her diaper had not been changed in quite some time. She also had a foley catheter in place, which was incredibly dirty and filled with purple urine. The paramedics relayed that her house was in the same filthy condition.
There is actually a syndrome called “Purple Urine Bag Syndrome.” It is a rare syndrome associated with alkaline urine and some urinary tract infections, and it is more frequently observed in chronically catheterized and constipated women. You can read more about this here.
A middle-aged obese man came altered after overusing street drugs and began to have respiratory distress in the ED. The respiratory therapists began to bag the patient. As he was unable to maintain his airway, the decision was made to intubate him. My senior residents perceived that I was looking on with eager eyes, and he invited me to participate in the intubation. I happily jumped at the opportunity. After an initial failed attempt to open the mouth and sweep the enormous tongue, I realized he was going to need some sedation and paralysis. We halted the intubation attempt for a few seconds while he was given 20 mg of etomidate and 100 mg of succinylcholine. After that, his mouth was much easier to open, but his tongue kept interfering with my view of his vocal cords. His short, stout neck did not help matters. My senior was forced to intervene and after a few futile attempts he finally asked for a gum elastic bougie.
He advanced the bougie through the trachea, then threaded the tracheal tube over the bougie. Good breath sounds were appreciated and the CO2 monitor turned from purple to yellow, indicating that the intubation was successful. He later told me that was the most difficult intubation he had ever done, and that I should not feel disappointed that I could not get it. I was grateful that he was considerate enough to let me try.
The University of Virginia has a quick review on how to intubate.
A 45 year-old male with no significant past medical history came in with a two-day history of blurry vision and generalized weakness, polyuria, and polydypsia. His blood sugar was found to be 577. He denied ever being diagnosed with diabetes or having any family history of diabetes. He did admit to using methamphetamine and drinking 5 or 6 cans of soda per day. His anion gap was only 10, so he was not in diabetic ketoacidosis. We simply treated him with subcutaneous insulin and sent him home on oral diabetic medications with a follow-up appointment with a family practice physician. I made it a point to come by before his discharge to encourage him to stop “shooting up” and to educate him about dietary reforms that he could make to prevent complications of diabetes later on. He admitted that one of his New Year’s resolutions was to stop using speed and to get a job. I told him that with God all things are possible and that it was within His power to help him with his terrible addiction. His eyes were bright, and I could see that hope rested in his heart.
Through my limited experience in dealing with patients over the last few years in my medical training, I have realized the gravity of our condition – the hold that sin has on our lives and on our health. The laws of temperance with regard to our appetite and base passions have been shamelessly broken. During this holiday season and as we approach a New Year, may we resolve to surrender our lives daily to Christ and claim freedom from the bondage of sin that he so freely promises. May we resolve to live healthy and pure lives. May we resolve to recommit our minds to the study of His Word and His will for our lives. May we resolve to fight sickness and poverty not simply for the sake of fighting sickness and poverty but for the spiritual transformation that accompanies the battle. Amen.
One gentleman came in after getting a huge mag-lite flashlight stuck in his rectum.
The X-ray of the pelvis was quite remarkable.
He was taken to the Operating Room for removal by the surgery team.
Photos courtesy of Dr. Lanny Hsu. Cell phone cameras often come in quite handy.
A middle-aged lady with history of multiple sclerosis was brought in by ambulance for vomiting. Her entire body reeked of a foul stench, and she was found covered in her own stool as her diaper had not been changed in quite some time. She also had a foley catheter in place, which was incredibly dirty and filled with purple urine. The paramedics relayed that her house was in the same filthy condition.
There is actually a syndrome called “Purple Urine Bag Syndrome.” It is a rare syndrome associated with alkaline urine and some urinary tract infections, and it is more frequently observed in chronically catheterized and constipated women. You can read more about this here.
A middle-aged obese man came altered after overusing street drugs and began to have respiratory distress in the ED. The respiratory therapists began to bag the patient. As he was unable to maintain his airway, the decision was made to intubate him. My senior residents perceived that I was looking on with eager eyes, and he invited me to participate in the intubation. I happily jumped at the opportunity. After an initial failed attempt to open the mouth and sweep the enormous tongue, I realized he was going to need some sedation and paralysis. We halted the intubation attempt for a few seconds while he was given 20 mg of etomidate and 100 mg of succinylcholine. After that, his mouth was much easier to open, but his tongue kept interfering with my view of his vocal cords. His short, stout neck did not help matters. My senior was forced to intervene and after a few futile attempts he finally asked for a gum elastic bougie.
He advanced the bougie through the trachea, then threaded the tracheal tube over the bougie. Good breath sounds were appreciated and the CO2 monitor turned from purple to yellow, indicating that the intubation was successful. He later told me that was the most difficult intubation he had ever done, and that I should not feel disappointed that I could not get it. I was grateful that he was considerate enough to let me try.
The University of Virginia has a quick review on how to intubate.
A 45 year-old male with no significant past medical history came in with a two-day history of blurry vision and generalized weakness, polyuria, and polydypsia. His blood sugar was found to be 577. He denied ever being diagnosed with diabetes or having any family history of diabetes. He did admit to using methamphetamine and drinking 5 or 6 cans of soda per day. His anion gap was only 10, so he was not in diabetic ketoacidosis. We simply treated him with subcutaneous insulin and sent him home on oral diabetic medications with a follow-up appointment with a family practice physician. I made it a point to come by before his discharge to encourage him to stop “shooting up” and to educate him about dietary reforms that he could make to prevent complications of diabetes later on. He admitted that one of his New Year’s resolutions was to stop using speed and to get a job. I told him that with God all things are possible and that it was within His power to help him with his terrible addiction. His eyes were bright, and I could see that hope rested in his heart.
Through my limited experience in dealing with patients over the last few years in my medical training, I have realized the gravity of our condition – the hold that sin has on our lives and on our health. The laws of temperance with regard to our appetite and base passions have been shamelessly broken. During this holiday season and as we approach a New Year, may we resolve to surrender our lives daily to Christ and claim freedom from the bondage of sin that he so freely promises. May we resolve to live healthy and pure lives. May we resolve to recommit our minds to the study of His Word and His will for our lives. May we resolve to fight sickness and poverty not simply for the sake of fighting sickness and poverty but for the spiritual transformation that accompanies the battle. Amen.
posted by janie and paul =) at 5:41 PM
2 Comments:
Amen! may God continue to use you in His service....
Nice, but I got that topped. Back in the x-ray tech days at Florida Hospital. ER too, took and xray on pale late 30's white male. DX: Glass coke bottle up the okole! Next day! I had to do the barium enema!
AH!
go sista Janie!
(okole:Pidgin Hawaiian talk = butt!)
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