Case of the day:

An ER patient recently set a record for shortest period of time to elapse between drunk driving arrests.  He clocked in at just over 12 hours.  In addition, he was arrested after crashing his car both times.

When you think about that, it’s actually kind of incredible.  He had to crash his first car, come into the ER, get checked out, be arrested, go to jail, make bail, then go get drunk again, drive another car, and crash again.

Now I firmly believe that alcoholism is a disease, and I truly sympathize with patients who are struggling with addiction.  But when I think about how incredibly dangerous this man is, and how little he regards the safety of other people, it makes me angry.

The nurses often make jokes when we have patients who behave this poorly, and I think it helps them deal with the stress of the ER.  This patient certainly increased their stress substantially, especially when he started to sober up, and made a point to give each of them the middle finger and some accompanying profanity.  He then tried to make a break for it, running down the hallway when the police turned away briefly.  His hopes for freedom were quickly dashed when the police wrestled him to the ground, and cuffed him.  The patient was quick to complain of police brutality, and threatened them with “I’ll have all your badges.”  Somehow, I think their badges will be just fine.

Q: With the financial crisis, have you seen more people with suicide attempts in the ER?

Stephanie – Henderson, NV

A:

Congratulations to you, Stephanie, for the most morbid question of the week. The answer is no, thank goodness, I have not seen more people with suicide attempts due to the economic crisis. I have seen quite a few people with anxiety who are struggling with financial problems, losing their job, family stress, etc. I would certainly strongly encourage anyone who is battling depression, or considering suicide for any reason to please get help. If you don’t know where to go, or who to talk to, contact the National Suicide Prevention Lifeline (1-800-273-TALK), or go to your local Emergency Department.

Accidents Happen

Recently, a man was brought in to the ER to see me, who had been in a car crash and was pretty banged up.  His pickup truck was hit head on by another vehicle.  He repeatedly stated how lucky he was that he was in his 6000 pound truck and that it probably saved his life.  Nevertheless, he had significant injuries, fractures, cuts and abrasions and the truck was completely totalled.  I asked him what kind of car hit him.

“It was an old lady in a Subaru,” he said. 

“Wow, what happened to her?” I asked, assuming she had been flown to another hospital.

“Oh she walked away,” he said, clearly perturbed that she was uninjured despite her tree-hugger car.

Do Not Touch

It’s tough to say what the dumbest injury I’ve ever seen is, but I’ll submit this for your consideration.  I had a patient who noticed a rattlesnake on the road, and decided to save it.  He was concerned the snake would get run over by a car.  He therefore walked up and grabbed it by the tail, thinking he would “sling it to the side of the road.”  Of course, the snake simply turned back on him, and bit his hand.

At this point, the patient decided that instead of saving the snake, he would club it to death with a large wrench.  For some reason, he kept the dead snake, and put it in a bucket.  He came into the ER, and had to get anti-venom for his snake bite.  I asked him why he thought it was a good idea to grab a rattlesnake, and he argued that he said “I grab snakes all the time, and I never get bit!”

“You mean, until today,” I said.

Two days later, he was back at home, and was “fooling around” with the dead snake.  Incredibly, he somehow was bitten again, this time on the other hand.  I’ve heard of bites from dead rattlesnakes happening right after they die, but I really don’t know how this could have happened two days later.  Fortunately for the patient, he did not appear to get anymore venom into his hand, but he did develop a wound infection and he came back into the ER for antibiotics.

When to Stitch a Wound?

Q:

Dear ER Doc

Is there a general rule to when a cut needs to be stitched up? 

With major cuts that are long and/or deep – it is pretty obvious that a trip to the hospital in needed. And for everyday minor cuts – it is equally obvious to wash it and slap on a band aid. 

                                                                                                                                                                                          But sometimes there’s an “in between” cut in my family. Be it me with a
kitchen knife or my son getting a cut from some glass on the playground.
These are not “minor” but I am not sure if it really makes sense to go
through the time and expense of getting stitches. Any thoughts?

A:

Briefly, the first thing you want to do is take a look at the wound and determine if the skin edges are lined up well.  Then, see if the skin stays together when the area is moved.  You will find that in highly mobile areas, such as fingers, wounds often open up when there is movement.  In this circumstance I will usually put in stitches to keep the skin edges together and healing.

Also, you want to be sure that there is no deep structural injury to the tendons, blood vessels, nerves, etc.  This often requires evaluation, and “exploration” of the wound by a doctor.  It is especially important to make sure there is no foreign material in the wound itself, and that the wound has been thoroughly cleaned.

This may not be a satisfying answer, but I usually tell people that if there is any doubt, have the wound checked out by a physician, so that proper wound care can be done.

Be sure and look at my upcoming entry on “when you cut yourself” as well.

A very anxious woman about 50 years old came in to the ER complaining that her skin had turned blue. “I was like this when I woke up!” she reported.

She was right. She did have blue skin, on her arms, legs, some on her face. The rest of her skin was normal.

“Have you ever seen anything like this before Doctor?” she said in a barely contained panic.

“I believe so.” I replied, as I opened an alcohol wipe and brushed it against her blue shoulder. The color came right off. “I don’t suppose you have a new set of bed sheets, do you?”

“Um, yeah, I guess I do.” She replied.

“Blue sheets, perhaps?”

She nodded, her face now turning from blue to pink.

Frankly, I’ve never believed in this superstition either, but there was one night where my faith was tested.  It was around 11pm, and a local police officer was standing at the nurses station doing some paperwork.  He was new to the force (a veteran would never do this), and of course he casually asked the charge nurse, “kind of quiet for a Friday, isn’t it?”

This resulted in an immediate groan from 3 nurses within earshot.  I chuckled, but decided the comment would have no effect.  How wrong I was.

Not 2 minutes went by and I heard the triage nurse yell with fear in her voice “I need some help out here, NOW!”

A young man had driven up to the ER doors with his brother sitting in the passenger seat.  His brother was not moving, not breathing, not doing anything.  He looked about 25 years old, but had the gray color of a very old man.  We grabbed him, threw him onto a gurney and proceeded to give every treatment, medication, that we had.  But he was dead.  There was no explanation for it, no accounting for it.  One moment he was alive, eating a hamburger with his brother, the next moment he was gone.  He had always been healthy, he wasn’t a drug user.  There was just no reason for him to suddenly die like that.

The rest of the night was chaos, both with an onslaught of other patients and dealing with the aftermath of a family suddenly torn apart.

Many night shifts later, I still think about that young man.  And no matter what is going on in the ER, I never use the word “quiet.”