So, Steve and I have had a few shifts together in the ER this month--tonight was another. We were sitting there talking about my hyponatremic seizure pt when all of a sudden we hear, "GSW at the door--NOW!" There was a massive rush to the main entrance of the ER, where a car was waiting with a guy in the back seat. He had a bullet entrance wound in his anterior neck. As we all approached the car to help the guy out, out of nowhere, a second car whips around the corner and screeches to a halt right behind the first car. Out jump 5 very scary-looking guys. Steve backed up to where I was already standing (just inside the entrance to the ER), and we waited for the guns to be pulled and the shots to start out. Visions of the TV series "ER" came to mind as my life flashed before my eyes--no way this was going to turn out well. Luckily, they ended up being our guy's "brothers," there for moral support.
I ended up climbing into the back seat of the car to help carry the pt out and to help get him on a stretcher. Unfortunately, the pt was offering no help (all limbs completely lax) and complained of difficulty breathing (yes, he complained of paralysis and difficulty breathing before we started helping him out). C4 and C5 Fxs. Pretty sad life left for our guy.
Unfortunately, less than 2 minutes later we had another GSW arrive by ambulance and then about 5 minutes after that another GSW arrived by car. We had already had one. My shift was over, so I left right after number 4 got there. Who knows what else came in afterwards--maybe Steve got to see some more?
4 comments:
Sounds crazy. Seems like the GSWs come in bunches.
Sounds like Toledo keeps it real though. (By the way, I heard some stuff about the DO surgery program in Toledo having some problems. Is this true?)
The place I'm switching to has an amazing amount of penetrating trauma. I was on trauma there on New Year's Eve, it was pandemonium.
Neck fractures in otherwise young, healthy people stink. For me though, I HATE dealing with sick kids. Not like ear infections, I mean really sick kids. Just hits too close to home.
About the DO surgery program--I haven't had much interaction with them. We've seen the residents in the ED, and they've done well for us there, so, most of the ED staff seems to like them all right. As far as the actual program, I'm not sure either the DO or the MD programs are very strong. Some of that is probably because the ED program continues to be strong--like WE run the trauma service and the surgery residents only take home call for anything that goes to the OR. We have surgery residents every month, but they don't do anything for trauma. Their only role is to help cover the general surgery aspect of the service (we cover the daily trauma services AND, additionally, we cover staff surgery about 3 times a week--stinks when you're on trauma on one of the nights you're covering staff surgery as well. The surgery residents take care of the surgery patients the next day and go to the OR if needed). Sorry if I confused you. Anyway, the short of it is that neither surgery program coming out of Toledo gets national recognition for strength of program. I've heard of some pushes for change, like taking over trauma--from the ED standpoint, I hope it doesn't happen. The strengths of our program are that we run trauma, neuro/neursurgery (and moonlighting as a first year), and life-flight. Take any of those away, and we lose a lot of draw.
As for dealing with kids--we do a month in the PICU. It was actually one of my favorite months. We had some sick kids, but what I liked is that since they are otherwise healthy (most of them), they pull out of their critical illnesses pretty well. Agreed: some of them are devastatingly ill, and it's sad to see them so ill. Those are the ones w/ other underlying illnesses, like cerebral palsy. Your heart goes out to them even when they are "healthy."
Ken, that was a crazy night!! It was dead after you left at 3:00am. Bytheway, Your hyponatremic patient that you signed off to me kept trying to climb out of bed. All he wanted was his tupee. Once he had this on he was all good. Everyone in the department had to walk by and see how ridiculous it looked on him.
Damon, I talked with a 2nd year DO surg guy. He doesn't know of anyone trying to change programs. They only have 4 residents (2 second years and 2 interns) and 3 main staff that they work with. MD service is stronger and bigger due to their association with the Unversity of Toledo. MD service is also much more intense with 30-40+ patients compared to the 1-10 pts on the DO service. I did a month on the MD service and it was by far the hardest rotation as far as time and scutwork (worse then 2 months of IM). I guess the program director for the DOs died a few years ago and they are still trying to rebuild from this. Its rumored that they'll except 3 next year and then 4 the following year. Damon, what hospital are you switching too and will you have Jason Begalke there too? He was on IM call last night with Ken and I.
I just heard that University of Michigan fired 2 of their CA1 residents and 1 of their CA3 residents in anesthesia!! Incompetance was the rumored reason. I have a friend who is a CA2 and he says that these people were pretty scary having them in the OR. They had done numerous things and received many warnings so it wasn't a big surprise there. Have you heard of residents being fired, let alone 3 from a program? I'm just hoping I don't have regrets once I start there in July.
1) I know for a fact that at least one resident at the DO program is looking for something else. And the reason being offered is that their program has to play junior varsity to the MD guys. I know the guy's name, but I don't really want to call him out on the publicly viewable Internet. Call me if your curious, I don't mind telling you. (Believe me, it's easy to be paranoid when you are looking to switch programs. The DO surgery world is amazingly small sometimes.)
2) Detroit Medical Center - Sinai Grace Hospital is where I'm going. Jason sent me an email the other day, he's heading there for anesthesia of course.
3) I can't speak for the U of Michigan, but we have one resident here who is not getting his contract renewed. They aren't firing him outright, they just told him that he needed to find something else because they weren't going to keep him around July 1. This guy pulls a lot of shady stuff, and isn't the most competent guy in the world either, but he probably can be worked with to improve. I don't know all the particulars of course, but it kind of stinks for this guy.
4) Ken, where I'm going we have some issues too regarding traumas run by ED vs Surgery. They way it works is that the ED run the surveys, with procedures being split up. There's no real rhyme or reason as to who gets the chest tube, for example. By default it goes to the ED if the Trauma chief doesn't want it for himself or have a junior try it. It just sort of works itself out. Just a rough guess is that ED does 2/3 of procedures.
However, no matter who is running the survey, the trauma team jumps in and participates as well. And while that is going on the trauma chief oversees from the foot of the bed and the trauma attending pow wows with the ED attending about what will happen with the patient. It's pretty cool because now matter what happens everyone works together cooperatively for the patient's sake.
And considering the volume of trauma, everyone knows that there will be plenty more incoming. My first trauma call had 13 trauma activations, and I was thinking "Wow, this is crazy." Nobody else was as impressed as I was, it was average to them.
I know what you're saying about ED run trauma being a big draw to your program. It's the same way here.
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