Hello, ERP here from ER stories.

The other day we had a woman come in the the ER with complaints of vague chest and back pain for many months.  We noticed she had never been there before and was from out of state.  When asked why she suddenly decided to come in for this problem, she stated that she a seen an ad for our hospital’s new ER on a bus in her neighbourhood and thought, “Hey, that hospital looks great! I think I will go over there right now!”.

Some of the docs joked about how our hospital’s marketing dept was doing too good of a job – in attracting the wrong type of customer!  This hospital wants insured patients to come and schedule elective surgeries and have expensive out patient studies done.  Instead, they got someone with out of state Medicaid come to the ER for a completely non-urgent problem.  (I was personally more annoyed about the fact that she came in for a chronic condition than her insurance status).  Anyway,  due to her Medicaid being out of state, she would not be able to follow up with any of our doctors or our clinic so she would wind up being referred back to her state.

Which is why I was more than suspicious when the lab mysteriously lost not one, but TWO sets of bloods that were drawn on the patient.  Thus she experienced a delay of more than two hours in getting a disposition.  She expressed her frustration by saying “Your hospital is not great at all!  I am not coming back!”.    Hmmmmmmmm.

Fractured Distal Radius (see Arrows)

Complete Posterior Elbow Dislocation

Hello, guest poster ERP here.

If you read my blog, recently I posted about the first “Ice” day of the year. The day that always seems to surprise people, haplessly stepping out onto the stuff in their driveway, front steps, or sidewalk. We always get a big bolus of patients with falls – often with nasty injuries.

Anyway, one of the poor guys I saw that day was the unfortunate owner of the above x-rays (well, ones that were nearly identical to them). He slipped backwards and fell while trying to get into his car. He was in a world of pain (and yes, before everyone goes crayzee, he got PLENTY of IV narcotics!). Realising that I had to reduce that dislocated elbow, and since he had not eaten or drunk anything since the night before, he was a perfect candidate for Dr Conrad Murray’s favourite drug, Propofol (administered by an anaesthesiologist since myself and my PA were doing the reduction – it can be hard to monitor the airway and do a procedure at the same time). Since I had to reduce the elbow (you really should not wait very long to do this), I figured why not try to reduce the distal radius fracture as well? (Not being an orthopaedist, I have only reduced a few of them, usually with the assistance of one). I figured that worse case scenario, he would need another reduction when he followed up with ortho in a few days.

We put the guy out and the elbow reduced easily – return to full range of motion was achieved in short order. Then I bent and yanked on that smashed wrist. The crunching sounds always sort of make me queasy but that is the way it is. I splinted the whole arm from shoulder down to the fingers and ordered the post-reduction X-rays. I thought they looked OK but what do I know? I could tell the elbow was in but I don’t know all those myriad of angles that orthopaedists have to memorise. (for most fractures, there is an angle between the fracture segment and the rest of the bone that you shoot for – and that is what determines if the reduction is successful and not requiring another attempt). About an hour later, the orthopod came in – he had a slew of patients as you can imagine that day – and looked at my handiwork. He deemed the reduction “acceptable” and appeared to be thankful that I had made his day a little easier. I felt like a med student who did his or her first suturing job that did not have to be redone by the attending who came to supervise! Now, I hope he will come in a little faster when I REALLY need him for that drunk guy with an open tib-fib fracture who will inevitably come in at 3am on a Friday night!

Hey all, I this is ERP from ERstories doing a guest post on Whitecoat’s Blog. I want to give him and the EP Monthly staff my thanks for accepting some of my occasional ramblings.

Drunk people are often victims of their own stupidity. However, just as often they manage to avoid disaster by some miracle. For example, intoxicated persons have a tendency to end up face down in the street and often manage to avoid getting run over. Sometimes they are even luckier. Of course they never really realise this since after all, they are drunk. Hopefully when they sober up they count their blessings but often they simply can’t remember enough!

Anyway, we had a guy who was brought in by police intoxicated outside someone’s house. Apparently he was visiting the area and was staying with someone in the neighbourhood. Unfortunately, when he stumbled home from the local watering hole, he went up to the front door of the wrong house. Frustrated by the fact that his key did not work and upset that no one answered his knocking, he preceded to kick the door in. He flopped partially into the doorway and nearly passed out. This of course triggered the house alarm and the police were notified. The responding officer sped rapidly to the scene for more than one reason. The door that had been kicked in belonged to the chief of police’s house! Expecting the worst, the cops showed up with Glocks drawn. Knowing the chief’s love of firearms and the fact that he was not afraid to use them, I imagine they thought they might encounter some OK Corral- type scenario. Fortunately for the guy, the police chief was not at home at the time. Otherwise, he would have likely been brought to the morgue instead of the ER! One more of his nine lives used up I guess….