Ok, so if you follow me on Twitter you might know my most famous tweet ever was about butt stuff.
Yes, people put stuff in their butt and lose it. No, we don’t really care that you do it anymore that we care that you put a ladder on top of a lawnmower to reach a chandelier and fell off it. People do dumb shit. They end up in emergency rooms.
Ok, so you already knew about that? Cool, let’s talk about other weird shit.
A foot can be mostly amputated and hanging on by a thin shred of tattered skin and muscle and the person CAN STILL WIGGLE THEIR TOES. I’ve seen it three times and it blows me away every time. The first time ever, the shoe was still on the foot and the surgeon told me to get their shoe off and I was like FUCK THAT I AM NOT RESPONSIBLE FOR TAKING A FOOT OFF although I actually believe I said “oh no thank you.”
Here’s the thing, I did then take it off but I made the paramedic who brought him in hold the foot the whole time so it didn’t move a millimeter. Later when the surgeon reduced the dislocation he pulled on that damn foot like he was in the Olympics and it didn’t come off so shows you what I know, right?
When the foot slipped back over the bottom of the tibia bone, and everything sort of contracted back together all the dirt and dried blood and clots came out in a big gush of black liquid. This was around the time I’d been watching a lot of Santa Clarita Diet and I said “is that ICHOR?” out loud though I meant to keep that thought internal. Whoops.
So if the nerves are intact, the shit can still move.
Priapism-the boner that won’t go away. Did you know cocaine can cause this? And OTC pills at gas stations? And all kinds of other medications?
Sounds cool, is pretty annoying and can be dangerous. Treatment is drainage and phenylephrine injection. Most of the time it works, but sometimes it doesn’t, which is bad. Problem with priapism isn’t just that it’s uncomfortable—the vascular congestion causes ischemia to the penile tissue. So how do you know if the penis is ischemic? You run a blood gas on it, same as you do to see if a patient is oxygenating! The first time a urologist handed me a syringe of penis blood and told me to get an VBG on it, I said “is this a joke?” But as it turns out, if the pH is low, it might have to go off to the OR for shunt placement. If that fails or gets infected, guess what. Just guess. That’s right! Amputation. Insert your choice of GIF here.
RIGHT?!?
Up until I started at a big fancy trauma center ER, I thought the dramatic movie moments where someone got stabbed in the chest and the knife actually PULSED with each heartbeat was pretty theatrical.
IT IS NOT.
It is REAL. My first came in with a knife handle protruding from their chest and EMS had padded the site with four by fours to ensure it didn’t wiggle around and you know, fuck some important shit up, and I swear to God EVERYONE WHO CAME IN THAT ROOM wanted to lift those four by fours up and take a peek until I was like STOP FUCKING WITH THAT. Not a single hallway bed that I passed complained that day, probably because we didn’t want to put something even as light a sheet over this huge ass knife and cause any problems.
The trauma surgeon told me later they had a big old laceration at the top of the left ventricle to repair and there were HUNDREDS of “nicks” in the bottom of the ventricle—every time it pumped the tip of the knife scratched the bottom. Pretty cool, right? Especially since the patient ended up not only surviving but recovering to their previous level of function.
Another thing I discovered working trauma—feathers are visible on x-ray. Say someone gets shot through a down jacket and there’s bloody feathers everywhere. Sweep those bad babies off because they’ll look almost exactly like bullet fragments or pellets on the film. Until you remember that you’ll all stare at that x ray trying to figure out why fragments are spread all over in places they can’t exist.
The thing about a gunshot wound, or a GSW, that you might not know—when cutting the clothes off the victim/patient, you gotta cut around the holes. Evidence and all. Also, you never call them as an entrance or exit wounds. Even if you think you know. That’s for people with masters in forensics.
I had a patient who took a shotgun blast to the chest and survived. Someone deemed forensically gifted was allowed to call the giant gaping hole in the side of the chest the exit would—during dressing changes we would pack the would with saline soaked gauze and stuff it in the hole—I could feel the heart beating right next to my hand. Crazy stuff.
Kids who get stuff stuck in their nose, like LEGO’s and peas—the first intervention, if their parent is willing, is to cover their mouth and have the parent blow in the opposite nostril very forcefully. Many times that object will become dislodged and come flying out, booger soaked and all. Easy fix. Otherwise that kiddo is probably getting burrito wrapped and held down while a medical professional digs around in their nasal cavity with instruments which is terrifying as hell for a toddler.
On that note, how do we get kids to do stuff? We explain it, we offer support and comfort, and try the path of least resistance. Sometimes we ask the parents to leave, because if you’re sobbing hysterically ‘my baby!’ over and over your kid is not going to be cool. They’re going to be scared out of their mind. We like for parents to be present until the it’s causing the kiddo more distress.
If the path of least resistance doesn’t work, there’s the papoose board, which I hate, because strapping a kid to a board for a minor procedure is overkill. I prefer the burrito for kids five and under. Roll them up with their arms against their sides and lay them against their parent of choice. Parent wraps their arms around the upper body, staff is responsible for legs—they still fight wrapped—and head. Sometimes it’s best just to get over with.
Older kids are pretty reasonable. Listened to a new doctor and a new nurse try to reason with a 9 year old for thirty minutes about getting a strep throat swab once, begging him to open his mouth, and finally I walked in and was like look dude, this is going to happen, ok? So here’s the deal, it doesn’t hurt. It’s a little uncomfortable, like when you jab your throat with a popsicle stick. It takes about 3 seconds. Then we had a brief chat about how it would happen if we had to force it and he was like ok cool I’ll do it. Older kids have the ability to understand choices and can also be bargained with.
I like kids. Kids are awesome. In fact, I would probably specialize in pediatrics if it weren’t for abuse and cancer. My heart just can’t take it.
That’s my thoughts on interesting stuff today!
— the Midwestern One