Binge Drinker

Another bad one yesterday. Teenager comes by via ambulance, binge drinking night before, rum, tequila (again) and some type of whiskey. Comatose since last night when friends dropped him off at a relative's home. Unable to revive him this morning, family called 911. Patient had aspirated vomit into his lungs so basically his alveoli had been fried by hydrochloric acid. And you thought smoking was bad for you! Glascow Coma scale was a 4 when he arrived.

Now the Glascow scale is kind of weird. Only scale I know of where you can score a 3 when you're dead! Our ER instructor used to show us pictures of people with their head's chopped off or someone who had been blown in half and ask "What's this guy's Glascow Score?" "Three" we would all reply. Your dining room table scores a three on the Glascow.

Anyway, this kid was a 4! Stuck a bunch of tubes in his throat and nose, I had to bag him while they were taking the CT scan which means I was literally straddling the scanner (I'm probably sterile now), and we called for a helicopter. Now we figure this kid was at three times the toxic level for alcohol last night. That's 8-9 TIMES the legal limit for driving! We got him stable, suctioned a bunch of garbage out of his lungs (his left lung wasn't even inflating when he came in), got some good meds on board, and sent him to an ICU (if you know where I am, you know it's the closest large metropolitan area 200 miles due south). The thing that will get him is; 1. Pneumonia, which is what will kill him if he doesn't make it; and 2. Brain injury from the lack of oxygen he suffered after his lungs were compromised. The adult (and I use the term loosely) that purchased the booze has been arrested and could be charged with manslaughter if the worst happens. Sad but a good illustration of what can happen if you go overboard with your hard liquor. Be careful out there, and know what your kids are up to and who they're with.

Good experience for me, bad experience for them.

-Bartman

UPDATE: http://www.lincolncountyrecord.com/

You'll love this one!

OK, 0447 am, 40 year old female patient arrives via ambulance to ER. It's the longest day of the year so it's already light over here! Weird. Patient reports she dislocated her shoulder TWO DAYS AGO! But for some reason chooses now to be seen. Pt does admit to having vicodin, lortab, and tequila on board at the time AND since the initial injury (this just gets better and better). So she gets x-rayed, shoulder looks like it's reduced itself back into place...then pt remembers that it did pop again sometime since the initial accident. What am I doing here? Unable to get information from patient what she was doing at the time of the accident, just that it involved tequila. Why did she come in now? Running out of Jose Cuervo and figured she's better get seen by a doc. Exam unremarkable except for pain at shoulder, and EXTREMELY constricted pupils. Pt failed mini mental status exam, but is VERY pleasant at times. Assesment: Status Post shoulder dislocation x2days, spontaneously resolved. Plan: Sling and swath arm, discharge patient home with unknown male that she seems to be familiar with. And no, she didn't get any more drugs! I love ER.

Oh yeah, and I passed a county sheriff running lights and sirens out of town...that's usually not good. So I stayed up and wrote this in case I get another call here in a minute to go back to the hospital. First days of summer! Only have a week to go with this rotation and it's already been more interesting any of my others!

-Bartman

Another funny one:

Loeb's (whoever he was) four laws of medicine.

1. If what you're doing is working, keep doing it.
2. If what you're doing is not working, stop doing it.
3. If you don't know what to do, don't do anything.
4. And above all else, don't let a surgeon get a hold of your patient.

Please wear Your SEATBELTS!

Here is a sad story. One guy was wearing his seatbelt, one wasn't. What do you think happened?

Falling asleep at the wheel is suspected as the cause of a single vehicle rollover on Panaca Summit May 23 that killed an Enterprise, Utah man. Lincoln County Sheriff Kerry Lee reported that 74-year old Gerald R. Durbin died in the accident that occurred about 12:30 Friday afternoon.

Panaca Ambulance and Panaca Fire Department responded along with the Sheriff’s Department and Nevada Highway Patrol. Lee said the accident happened about eight miles east of Panaca with the westbound car, a late 90s Lexus, leaving the road and rolling over a few times, throwing Durbin from the car. A passenger, 44-year-old Pete Bernardo, suffered a small cut on his ear and minor bruises. He (Bernardo) said he was wearing his seat belt, but Mr. Durbin was not. Bernardo told officers he thought Durbin had gone to sleep because he yelled at him to wake up just before the accident happened.

Lee said it appears the car drifted off the right side of the road, missed a little bit of a left curve in the road and hit the shoulder. Durbin then overcorrected the car, skidded across the road to the left side, rolled down the south side embankment and he was thrown out. Lee said poor weather on the summit was not likely a factor in the accident.

Please wear your seatbelts. -Bartman