CAdamsPAC Posted August 15, 2023 Share Posted August 15, 2023 8 hours ago, EMEDPA said: So shift is almost over. Just caught up. Started with a rapid response on the floor for a pt who needed bipap, followed by a peds code and a fairly sick DKA pt. We worked the peds code for 2 hrs. Every rhythm in the book. intubated , central line, 2 finger thoracostomies for good measure, 2 pressors, pacing, you name it. A few brief episodes of ROSC, but poor eventual outcome. This one was rough. We can only do our best, not every patient can be saved. Strong work! 2 Quote Link to comment Share on other sites More sharing options...
sk732 Posted August 17, 2023 Share Posted August 17, 2023 On 8/15/2023 at 6:24 AM, EMEDPA said: So shift is almost over. Just caught up. Started with a rapid response on the floor for a pt who needed bipap, followed by a peds code and a fairly sick DKA pt. We worked the peds code for 2 hrs. Every rhythm in the book. intubated , central line, 2 finger thoracostomies for good measure, 2 pressors, pacing, you name it. A few brief episodes of ROSC, but poor eventual outcome. This one was rough. My opposite number here had a youngster drown here with prolonged down time - they got ROSC but the kidlet died in ICU a day or two later. The community across the lake from us had another kid drown the same weekend, PA there worked them for a long time but to no avail. Serious suckage. 2 1 1 Quote Link to comment Share on other sites More sharing options...
CAdamsPAC Posted August 17, 2023 Share Posted August 17, 2023 (edited) 21 hours ago, sk732 said: My opposite number here had a youngster drown here with prolonged down time - they got ROSC but the kidlet died in ICU a day or two later. The community across the lake from us had another kid drown the same weekend, PA there worked them for a long time but to no avail. Serious suckage. Kidos get beyond reasonable resuscitation efforts, I couldn't face myself if I did less. Edited August 17, 2023 by CAdamsPAC clarity 3 2 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted August 20, 2023 Share Posted August 20, 2023 When half of your patients have blood alcohol levels higher than your bowling scores ... 2 1 Quote Link to comment Share on other sites More sharing options...
SedRate Posted August 20, 2023 Share Posted August 20, 2023 3 hours ago, ohiovolffemtp said: When half of your patients have blood alcohol levels higher than your bowling scores ... Ehhhh my bowling score is 115, so that's just another Tuesday night for me. 2 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted August 20, 2023 Share Posted August 20, 2023 3 game total ... Quote Link to comment Share on other sites More sharing options...
SedRate Posted August 21, 2023 Share Posted August 21, 2023 That's some dedication Quote Link to comment Share on other sites More sharing options...
CAdamsPAC Posted August 21, 2023 Share Posted August 21, 2023 On 8/20/2023 at 7:59 AM, ohiovolffemtp said: When half of your patients have blood alcohol levels higher than your bowling scores ... And they come in at 2am for a 3 week old problem and asks you to check out all of their kids!! 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted August 23, 2023 Share Posted August 23, 2023 Before starting to work in the southwest, I had some experience treating severely intoxicated patients, but nothing like what I do on a daily basis. The hospital I work at in northern AZ is right outside a reservation. The res is dry but the town isn't. We routinely see patients with blood alcohols in the 400's. Our ED has a semi-circle of wheelchairs with large chux pads on them and seatbelts. We evaluate these patients and if there are no other concerning findings, patients are put there to "metabolize to freedom". Sometimes they get IVF and/or banana bags. They then sleep until they can ambulate reasonably well and then they leave. It's not uncommon for them to return the same day, having gone off, consumed more, and then being found again by PD or someone who calls 911. Almost all have no interest in treatment. 2 1 Quote Link to comment Share on other sites More sharing options...
CAdamsPAC Posted August 23, 2023 Share Posted August 23, 2023 8 hours ago, ohiovolffemtp said: Before starting to work in the southwest, I had some experience treating severely intoxicated patients, but nothing like what I do on a daily basis. The hospital I work at in northern AZ is right outside a reservation. The res is dry but the town isn't. We routinely see patients with blood alcohols in the 400's. Our ED has a semi-circle of wheelchairs with large chux pads on them and seatbelts. We evaluate these patients and if there are no other concerning findings, patients are put there to "metabolize to freedom". Sometimes they get IVF and/or banana bags. They then sleep until they can ambulate reasonably well and then they leave. It's not uncommon for them to return the same day, having gone off, consumed more, and then being found again by PD or someone who calls 911. Almost all have no interest in treatment. One of the reasons I lost interest in inner city university EM!! Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 23, 2023 Author Moderator Share Posted August 23, 2023 10 hours ago, ohiovolffemtp said: Before starting to work in the southwest, I had some experience treating severely intoxicated patients, but nothing like what I do on a daily basis. The hospital I work at in northern AZ is right outside a reservation. The res is dry but the town isn't. We routinely see patients with blood alcohols in the 400's. Our ED has a semi-circle of wheelchairs with large chux pads on them and seatbelts. We evaluate these patients and if there are no other concerning findings, patients are put there to "metabolize to freedom". Sometimes they get IVF and/or banana bags. They then sleep until they can ambulate reasonably well and then they leave. It's not uncommon for them to return the same day, having gone off, consumed more, and then being found again by PD or someone who calls 911. Almost all have no interest in treatment. sounds like one of the facilities I work at...vacation destination. Nice summer weather. 1 Quote Link to comment Share on other sites More sharing options...
sk732 Posted August 27, 2023 Share Posted August 27, 2023 On 8/20/2023 at 6:59 AM, ohiovolffemtp said: When half of your patients have blood alcohol levels higher than your bowling scores ... Scary thing is for some, that's their sober level... 1 Quote Link to comment Share on other sites More sharing options...
CAdamsPAC Posted August 27, 2023 Share Posted August 27, 2023 38 minutes ago, sk732 said: Scary thing is for some, that's their sober level... What always concerned me was the residents in the ED feeling that these patients needed to sober up before they could leave the ED!! I couldn't convince many that these people lived at what would be seriously drunk for you or I. It usually took a senior attending or a ED hallway etoh withdrawal sz to get through to them to turn chronic inebriated folks loose in their own steady state! 1 Quote Link to comment Share on other sites More sharing options...
sk732 Posted August 27, 2023 Share Posted August 27, 2023 5 minutes ago, CAdamsPAC said: What always concerned me was the residents in the ED feeling that these patients needed to sober up before they could leave the ED!! I couldn't convince many that these people lived at what would be seriously drunk for you or I. It usually took a senior attending or a ED hallway etoh withdrawal sz to get through to them to turn chronic inebriated folks loose in their own steady state! Take that one step further and trying to get some psych nurses/MD's to interview them when they're suicidal - "Well, they have a high ethanol level", despite me (who see's them regularly and knows when they're level is actually high) telling them that they are quite sober when you talk to them. 1 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 28, 2023 Author Moderator Share Posted August 28, 2023 2 hours ago, sk732 said: Take that one step further and trying to get some psych nurses/MD's to interview them when they're suicidal - "Well, they have a high ethanol level", despite me (who see's them regularly and knows when they're level is actually high) telling them that they are quite sober when you talk to them. our psych folks won't see them until they are less than .08, so they end up getting phenobarb, ativan, and clonidine to ward off withdrawal....then they are "too tired to participate meaningfully in their exam". 3 Quote Link to comment Share on other sites More sharing options...
sk732 Posted August 28, 2023 Share Posted August 28, 2023 34 minutes ago, EMEDPA said: our psych folks won't see them until they are less than .08, so they end up getting phenobarb, ativan, and clonidine to ward off withdrawal....then they are "too tired to participate meaningfully in their exam". 1 Quote Link to comment Share on other sites More sharing options...
CAdamsPAC Posted August 28, 2023 Share Posted August 28, 2023 34 minutes ago, EMEDPA said: our psych folks won't see them until they are less than .08, so they end up getting phenobarb, ativan, and clonidine to ward off withdrawal....then they are "too tired to participate meaningfully in their exam". circular logic to prevent psych transfer/admission! 2 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 28, 2023 Author Moderator Share Posted August 28, 2023 2 hours ago, CAdamsPAC said: circular logic to prevent psych transfer/admission! and then when they are sober they all leave ama after spending 24+ hrs in the ED. Cya again next week! Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted August 28, 2023 Share Posted August 28, 2023 Or the mental health workers in CO who require someone to be in the ED for 12 hours if their UDS pops positive for meth, even if they have been medically cleared and are clinically sober. 1) it is CO - meth is everywhere 2) meth will continue to show positive in a UDS for how many days? (rhetorical, it's at least 3) Sigh, like EMED says, nothing like being bored in an ED to get people to leave AMA. 1 Quote Link to comment Share on other sites More sharing options...
sk732 Posted August 28, 2023 Share Posted August 28, 2023 11 hours ago, CAdamsPAC said: circular logic to prevent psych transfer/admission! How polite of you to describe obstruction like that ...you sure you're not Canadian? 6 hours ago, ohiovolffemtp said: Sigh, like EMED says, nothing like being bored in an ED to get people to leave AMA. I help the boredom by ensuring their bladders are full - encourages them to wake up faster. 1 2 Quote Link to comment Share on other sites More sharing options...
CAdamsPAC Posted September 1, 2023 Share Posted September 1, 2023 On 8/28/2023 at 10:12 AM, sk732 said: How polite of you to describe obstruction like that ...you sure you're not Canadian? I help the boredom by ensuring their bladders are full - encourages them to wake up faster. And........no lunch boxes! On 8/28/2023 at 10:12 AM, sk732 said: How polite of you to describe obstruction like that ...you sure you're not Canadian? I help the boredom by ensuring their bladders are full - encourages them to wake up faster. 1 Quote Link to comment Share on other sites More sharing options...
CAdamsPAC Posted September 1, 2023 Share Posted September 1, 2023 On 8/28/2023 at 10:12 AM, sk732 said: How polite of you to describe obstruction like that ...you sure you're not Canadian? I help the boredom by ensuring their bladders are full - encourages them to wake up faster. Well, I am not a coffee drinker, nor do I enjoy Tim Horton's donuts! So that excludes me from being a Canadian, but I am a Hoser! Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted September 4, 2023 Share Posted September 4, 2023 When you have to move a cow off the curvy mountain road so you can get between your sites ... 1 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted September 6, 2023 Share Posted September 6, 2023 Just treated my 1st case of HAPE - high altitude pulmonary edema. Rx: IM dexamethasone, 1 duoneb neb tx, 1 full tank of gas to drive to lower altitude. Pt was on an elk hunt, got up to about 12,000'. Been here less than 1 week, lives at about 800' elevation. Fortunately, pt has no hx of respiratory or cardiac dz and is a non-smoker. 1 2 Quote Link to comment Share on other sites More sharing options...
CAdamsPAC Posted September 13, 2023 Share Posted September 13, 2023 2 1 Quote Link to comment Share on other sites More sharing options...
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