Today I got up at 10.  That is 10pm because I am working nights in the ER this week.  When I walked in, there was a flurry of activity, as there often is.  Within a short time of arriving I was taking care of patients with chest pain, headaches, shortness of breath, and others, patients of every age group.

We had a woman come in my EMS who had been seizing for over an hour.  Some Ativan stopped the seizing, but she was unresponsive and not breathing very well.  We knew we had to act fast, so the ER doc asked how many patients I had intubated.  My reply was “successfully?”  Of course I have been through ACLS, I was even an EMT long ago, but I have only attempted intubation twice, and somehow thin patients with widely patent airways don’t seem to need intubation.  The attending talked me through the procedure.  We got everyone in place.  He stood at my left hand as the nurse pushed the etomidate and then the succs.  Laryngoscope in, lift up and away, there are the cords, and in goes the tube.  Just like it’s supposed to go.  Color change, bilateral breath sounds, symmetric chest rise.  Good job.  And the lab calls with a pH of 7.02

Later that same night we have a man who was in the lobby of the nearby psych hospital and decides to take benzos, opiates, adderall, and cocaine.  He presents via EMS minimally responsive, breathing 12 times a minute, and his belly seems tender.  Two uppers and two downers on board, and the downers are winning.  Tox screen and supportive care—he was still sleeping it off when my shift ended.

In the mean time we had a 16 year old boy come in who had been test driving his motorcycle without a helmet.  He hit a pot-hole (Indiana’s third largest cash crop after corn and soybeans) and lost control.  He never lost consciousness.  We performed a rapid trauma assessment, scanned his head and neck, x-rayed his hands, elbow and ankle, and tried to clean him up a little. In the end, he got away with two stitches above his eye and a lot of bruising and road rash.  His doc wants him to be watched overnight, so we send him upstairs.

My shift ends at 7 which gives me time to eat breakfast, change and do a little reading before I go to my morning clinic.  I only have three patients scheduled. One doesn’t show.  One takes about 45 minutes because she has a lot of chronic problems and likes to talk.  And I have an add-on.  This man is a hard-working 30something man who injured his back while lifting his paralyzed mother out of the bath tub a few weeks ago.  Some odd symptoms prompted a colleague to send him for MRI and to Neurosurgery.  He comes back to me with nothing but pain.  He is worried that he cannot afford PT or continued office visits.  He cannot work while taking narcotics, and he can’t be off work because he must support his family.  He can barely walk due to the pain.  Just touching his back and I can feel the terrible muscle spasm from ilium through the thoracic spine.  He has no normal rotation through his thoracic spine, and his sacrum is obviously twisted.  The good news is I think I can fix this.  We try some OMM  which he tolerated fairly well, but I can’t get much to move due to pain and spasm.   I told the patient to come back in two weeks when I have an opening, and to make sure he takes his meds before he comes in.  I am hopeful we can get him back on his feet, and he seems encouraged.

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