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#101 A. Breslin

A. Breslin

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Posted 16 March 2019 - 06:29 AM

'So you didn't hit your heard or lose consciousness, right?'

 

 

'Are you hurting anywhere else? You were walking around okay when they showed you to this room just now?'

 

'Any weakness, dizziness, Nausea or vomiting?'

 

*This is why I hate doctors. I hate answering questions. I hate this. I really do.*

 

'No issues, I didn't hit my head my side and hip took most of the fall but my sides the only thing that hurts. I didn't lose consciousness just a fall from standing height after seeing two people get murdered right in front of me.'

 

*At the very least maybe I can get the rest of the week off with some muscle relaxers.*

 

'I also have some muscle tightness towards my back'


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Paramedic Lieutenant Alyssa Breslin
EMS Duty Officer (EDO-1)


#102 Dr. Grant

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Posted 16 March 2019 - 06:46 AM

'Okay.' I reply as she snaps a bit at me.

 

'Yeah, I felt you back muscles were tight, but thats not surprising. That should resolve on its own.' I say. 

 

I pull up a chair and have a seat in front of her just below eye level.

 

'Okay, so everything looks fine...I don't think your right side is broken or anything, just badly bruised, as I'm sure you figured already. In fact I'm not even going to X-Ray it. It's not worth it. Even if there was a fracture it would be so small that it would be difficult to see on the X-ray anyway...and in all honesty...it's not really going to change the treatment plan.' I pause.

 

'So ice is good. I'll be sure to get you an actual bag of ice here as soon as we're done. I'll also write you a prescription for Motrin. It's really up to you if you want to fill it, otherwise you can pick up some ibuprofen at the dollar store. 600 to 800mg every 6 hours as needed. You can add Tylenol if you want. 1 gram also every 6 hours...but no more than 4 in a single day unless you want to pile drive your liver.'

 

'This whole thing should start to feel better within a week or two. If it doesn't, you need to follow up with the occupational health clinic the department has you go to since this is a worker's comp deal....and I don't have to tell you but if you have trouble breathing or it gets worse come back immediately. If you need a work excuse I can provide one for the rest of the day or even the next couple of days.'

 

Again I pause.

 

I change my tone from matter-of-fact to one of genuine concern.

 

'So I know this whole situation was a mess, and I can't even imagine what you've just been through....but uh....how are you holding up given the circumstances?'


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital

#103 A. Breslin

A. Breslin

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Posted 16 March 2019 - 06:59 AM

*Dr grant gives me his, "Your not getting any sort of fun meds don't try speech". *

 

 

'Thanks, Doc. I'm going to take it easy for the rest of the week. I can get back to work Monday. The past 2 or so hours have been a lot.'

 

*As I feel it starting to wrap up I hear Dr. Grant's tone change to one that I am familiar with but I hate. I know it's out of concern and its not the first time I heard it.*

 

'So I know this whole situation was a mess, and I can't even imagine what you've just been through....but uh....how are you holding up given the circumstances?'

 

'To be honest, Not great but I've made it through a lot worse before. When I was 16 I was in a car accident where my best friend was killed. If I can get through this shouldn't be that bad.  At this point, I just want to go home, Lay down on my couch and eat ice cream and drink wine with my little sister and then try to forget this whole thing.'


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Paramedic Lieutenant Alyssa Breslin
EMS Duty Officer (EDO-1)


#104 Dr. Grant

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Posted 16 March 2019 - 07:24 AM

I listen to what she has to say.

 

'Yeah.' I say softly and nod as she speaks.

 

She finishes.

 

'Well you sound like a very strong person...and it sounds like you have a strong support system at home, which is super important in situations like this.'

 

*small pause*

 

'I'm sure there's going to be a critical incident strep debriefing soon with everyone involved. Like I told the deputy that came in with you, it's super important for you to go and participate, if not for yourself, then to help support anyone else that might be having problems with this event. I know you're strong, but be mindful, a stressful event like this can be hard on anyone and different people handle it different ways. So keep a close eye on yourself, and take advantage of the support you have both at work and at home. You work with a good bunch of folks, and I know you all are like family so don't be afraid to seek help if it's needed.'

 

*Small pause*

 

'I apologize if it sounds like I'm being overly concerned about all this, but this is something I care a lot about. I...I remember what it's like to be in the field, and I just want to make sure you have the support you need.'

 

I break the somber mood a bit.

 

'Okay. So I'll get you the prescription, the work excuse, and once I get those for you, you can be on your way.'

 

I stand up and move the chair back against the wall where I found it.

 

As I go to exit the room I turn around.

 

'Before I go, do you have any questions for me? Or it there anything else you need?'


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital

#105 A. Breslin

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Posted 17 March 2019 - 08:37 AM

*Dr. Grant listens to my story about what happened and nods.*

 

'Well you sound like a very strong person...and it sounds like you have a strong support system at home, which is super important in situations like this.'

 
*I think to myself this is kind of bullshit, as I really only get along with my little sister and its not like I can tell her much because I feel the need to protect her from a lot. I hear the doctor touch on the debriefing and I nod when he mentions that I should go. *
 

'I apologize if it sounds like I'm being overly concerned about all this, but this is something I care a lot about. I...I remember what it's like to be in the field, and I just want to make sure you have the support you need.'

 
'I appreciate it, doctor. I will definitely go.'

 

*He gets up and walks towards the door.*

 

'Before I go, do you have any questions for me? Or it there anything else you need?'

 

'I should be good, Doctor. Thank you again. I'll see you at the next QA/QI meeting?'


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Paramedic Lieutenant Alyssa Breslin
EMS Duty Officer (EDO-1)


#106 Dr. Grant

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Posted 17 March 2019 - 05:44 PM

*I give a little smile when she says she'll see me at the next QA/QI meeting*

 

'You bet.' I say.

 

*I turn back around and exit the room, making my way to the nursing station and grab a computer. I log in and start typing up both encounters*

 

Click...click...select...click...type type type...click...type type....click click...it takes me a few minutes to finish Hawke's note.

 

Click...click...I open up Breslin's record and start my note in there.

 

Click...click...type type type type...click...her note take a couple minutes longer.

 

*I see both Breslin's and Hawke's nurse*

 

'Angie, 11 and 12 are good to go. 12 has a Motrin prescription that I'm printing now.' I say.

 

She looks up from her work. 'Alright, I'll get them discharged as soon as I'm done here.' she says.

 

'Thanks' I reply. Angie's a good gal. She works hard.

 

*I return my focus to the computer*

 

Click click click...who's next...


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital

#107 Dr. Grant

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Posted 18 March 2019 - 04:30 AM

"Trauma In-bound, auto vs ped, one patient. Alice, make sure he's hooked up to our monitor and get me vitals as soon as you can. Jay, you're scribing. Dr. Taylor, you're on physical, Dana, you're assisting Dr. Taylor." shouts Dr. Chen, the third year resident in charge of the trauma team today.

 

*Everyone confirms their role.*

 

The pride and an aura of control radiate from him in this pinnacle moment. In a few short months, he and his fellow third year residents are about to complete their training and be sent into the world to be on their own. This guy's a strong leader, and I have little doubt that he'll do well with this patient.

 

Today is an easy one for me: I get to babysit the Emergency Medicine residents over in Trauma. Luckily for me, it's the second half of the year, and my third years know more than enough to make it through and keep track of the first and second years. My job is to make sure the third years are doing the right thing and to educate the residents when a teachable moment comes up. In other words...baby sitting...but that's just fine by me.

 

The trauma team is getting organized. There is loud chatter and a clatter of things moving around. The patient's ETA is about 1 minute. Everyone's getting into position and gowned up. No one knows what to expect.

 

*I walk up to Dr. Chen from behind and place my hand on his shoulder.*

 

'Who's on airway?' I ask quietly into his right ear from behind.

 

'Ummm...' he pauses.

 

'Well, I think you better find someone.' I say to him. He immediately starts looking around.

 

*I start look around as well and see a victim. A first year intern.*

 

'What about Dr. Jensen over there?' I suggest to Dr. Chen. He looks over where I'm pointing and see's the Intern washing his hands halfway down the hall.

 

'Dr. Jensen! I need you.' he says loudly while gesturing for the first year resident to come to the trauma bay.

 

*The Intern looks confused as he approaches.*

 

'Dr. Jensen we have a trauma coming in and I need you on airway.' Dr. Chen commands the young intern.

 

'You got it.' Dr. Jensen says with forced enthusiasm as he starts to gown up and get into position.

 

The intern looks a little terrified. I think this is only his first or second day in the ER. Although he is an Emergency medicine resident, his year up to this point has been spent rotating through other areas of the hospital. Now he's being thrown into the fire. I almost feel bad for him. Unfortunately for him, I'm a big fan of the Intern experience.

 

*I hear a commotion out in the hall. The patient is here. The commotion grows louder. I see a gurney and a paramedic walking along side, one hand on the patient's chest doing one handed compressions.*

 

This isn't a good start.

 

*The EMS crew arrives at the trauma bay and brings their gurney along side the trauma table. The paramedic doing compressions starts giving report as everyone works to move the patient over.*

 

'Alright people we have a 16 year old male, auto vs ped hit at approximately 50 miles per hour. He was found unconscious on our arrival. GCS 2-3-2. He's got bilateral battle's signs, and an open fracture of the left femur, and left chest instability.' The paramedic pauses as they move the patient over. He hands off compressions to one of the trauma techs and stands back to finish his report.

 

'Last vitals were 68/40 hr 134, respirations 12 and irregular. He lost pulse as we were pulling in, before I could tube him. Monitor showed V.fib, I got one shock off before we came inside. No drugs, and 2 large bore IVs with saline running wide.' he finishes.

 

*The team begins doing their assigned tasks*

 

'Name? History?' Dr. Chen asks.

 

'Kevin Laforte, no history or anything that we know of. The mother rode in with us. This whole thing happened out in front of their house. I guess some drunk was speeding down the street and hit him from behind while he was walking down the side of the road. The driver left the area too...the coward....anyway the mom's out in ambulance reception.'

 

'Thanks.' Dr. Chen refocuses his attention on the resuscitation at hand.

 

'I have bilateral battle's signs and fluid leakage from the right ear.' Dr. Taylor reports as she is examining the patient.

 

'Can we stop CPR for a rhythm check please.' Dr. Chen commands.

 

*Everyone stops for a moment*

 

'Okay V. fib. charge to 200, continue CPR' he commands. 

 

'Left pupil is blown, both are non-reactive to light.' Dr. Taylor states. 

 

*Dr. Jensen is preparing to intubate while a tech is actively bagging the patient.*

 

*The Defibrillator beeps. It's charged.*

 

'Alright everyone stop and stand clear for a shock' Dr. Chen commands.

 

*He nods to Alice, the nurse working the defibrillator.*

 

'Clear.' she says before hitting the shock button. 

 

*The patient's body jerks with the shock.*

 

'Continue CPR' Dr. Chen states. 'Lets work on getting that airway secure.' he says staring at Dr. Jensen, who is struggling to get the intubation.

 

'Negative JVD or tracheal deviation....I have a deformity ribs 7-9 on the left!' Dr. Taylor shouts over the noise.

 

*The room grows incredibly loud with chatter. Emotions are running high. People have to shout louder and louder to hear each other over the growing roar of commotion.*

 

'I have upper abdominal rigidity! Pelvis is stable!' Dr. Taylor shouts.

 

*I step forward*

 

"EVERYONE!" I shout to get their attention. The rooms quiets a bit.

 

"I need you all to calm down and keep the volume reasonable. You're all doing the right things, so take a deep breath and keep doing what you're doing." I say in hopes of calming everyone down. It works to a degree.

 

'I have an open fracture of the left femur and some instability in the right. Can I get a bulky dressing, please?' Dr. Taylor asks her assistant.  

 

*From behind me comes Dr. Gegoravic, a tiny female fourth year trauma surgery resident. She must have been behind me the whole time, waiting for the perfect opportunity to jump in.*

 

*Dr. Gregorvic grabs the ultrasound machine and starts doing a FAST exam on the patient. She takes the probe and checks the predetermined areas.*

 

'Can I get 1 milligram of epi onboard please?' Dr. Chen asks. Dana, a nurse, acknowledges and preps the drug for administration.

 

*I step forward again*

 

'Where's that airway?' I ask loudly for Dr. Jensen to hear me.

 

'I'm working on it.' he says, struggling with the laryngoscope trying to visualize the vocal cords.

 

'Let's go Dr. Jensen. Every second that ticks by is a second he's not getting oxygen.' I say.

 

'I hhhave positive Morrison's' Dr. Gegoravic says in her thick Eastern European accent as she ultrasounds the liver.

 

*I take a peak at the ultrasound screen.*

 

This poor kid  has a massive amount of blood around his liver.

 

*Dr. Gegoravic continues the exam. She checks the heart, no blood around the heart. She checks the spleen....*

 

'Christ. All I see is blood.' she says out loud.

 

'Dr. Jensen, how long are you going to take on this attempt? Bag him..and try again.' I say a little angrily. 

 

'I got it!' he says triumphantly. as he slides the tube in.

 

*A tech connects the bag valve mask to the tube and starts ventilating. Dr. Jensen starts to listen. Curious, I walk over as well to double check.*

 

*I place my stethoscope on the patients left lung. I can't hear anything. I check the stomach. I hear nothing, which is good. Then I check the right lung.*

 

'It's good. Keep ventilating.' I hear Dr. Jensen say.

 

*I hear good lung sounds on the right. No sounds on the left, but good sounds on the right....this isn't a good tube.*

 

'Which patient are you talking about Dr. Jensen?' I ask. He looks at me confused.

 

'Because this patient has a right endobronchial intubation.' I say in a bit of a smart alleck-y way.

 

*He looks at me in disbelief...and listens again.*

 

'Crap.' I hear him mutter as he listens to the left lung. 'Okay lets remove it' he says disappointedly. 

 

'No no. You don't have to remove it. how do you fix this?' I ask.

 

*He looks at me like a deer in the headlights*

 

'Come on man, the medical students could answer this.' I say to him. Still nothing in reply.

 

'Withdraw the tube just a little bit' I say. His eyes light up and he begins to do so.

 

A small retraction of the tube and he now has good lung sounds bilaterally.

 

'There you go.' I say as I take a stand back.

 

'Okay everyone stop CPR.' Dr. Chen commands. He checks the monitor. A sinus tachycardia appears on the monitor.

 

'Is there a pulse?' he asks.

 

'No.' Dr. Jensen replies as he feels for a carotid pulse.

 

'Alright resume CPR' Dr Chen says.

 

*I take a step back out of the way and continue to watch. Dr. Gegoravic comes along side me, her assessment complete.*

 

'I'm going to have to do a thoracotomy, but this boy has no chance. His liver is torn, his spleen has exploded, he has unknown brain injury. It's not good.' She confides in me before she starts to set up to open the boy's chest.

 

*I leave the trauma bay and make my way out to ambulance reception. A see a woman sitting in a chair against the wall, trying her hardest to hold back tears. This must be the patient's mother. I ask the nurse running ambulance triage if the woman was indeed the patient's mother. She tells me it is. Now I know.*

 

*I walk back to the trauma bay. It's a bloody mess. Dr. Gegoravic is wrist deep into the side of the patient's chest, doing a manual heart massage. The patient's skin filleted open partially across his chest. I walk up to Dr. Chen and get his attention.*

 

'The mother of the patient is out in the hallway over there. Before you call this, it's usually good to tell her that things aren't looking good...that way she can start preparing herself for the bad news.' I say to him softly. 

 

*He nods back at me*

 

'What's the survival rate of a multi-system trauma patient who has an open thoracotomy?' I ask Dr. Chen to see if he remembers.

 

'Less than 1 percent' He says sadly, realizing that this kid has virtually no chance.

 

*I take a few steps back. The resuscitation continues. At the 20 minute mark, Dr. Chen makes his way out to talk to the patient's mother. When he returns he see's that no new progress has been made. After a few more minutes he's had enough.*

 

'Okay everyone stop.' He says as he checks the monitor. PEA.

 

'Someone check a pulse' he states.

 

A reply of 'no pulse' is returned.

 

'Alright...uh...I think we've done enough here. Anyone have any further suggestions or objections to calling it right now?' he asks.

 

Everyone remains silent.

 

'Okay then. Time of death 17:53' he says in a defeated voice.

 

*Everyone starts cleaning up and turning off all the equipment. I turn around and head back out of the trauma bay and grab a drink from my water bottle. Dr. Chen approaches me.

 

'Now here's the part I hate the most. Baring bad news.' he says giving a nervous chuckle.

 

'You did good.' I tell him, 'unfortunately it just wasn't in the cards for him.' I say.

 

'When I went out into the hallway to update his mom....she...she uh...begged me to save him...she told me that he was her only son and that he was the only one she was ever able to have....' he sighs heavily. 'She's not going to like this....'.

 

*I place my hand on his shoulder*

 

'It'll be alright' I say reassuringly.

 

'Over the past 2 and a half years I've been here, I've had to tell a lot of families that their loved ones have died....and oddly enough...it hasn't gotten any easier.' he tell me.

 

'And it never will.' I interject.  'Even after six years, I have to hold back my own tears when I give bad news.' I say to him in reply.

 

*He walks away, dragging Dr. Jensen, the poor intern on his second day in the ER, off with him. The social worker is close on their tail*

 

*I take a seat at the nurses station and start doing some work. 15 minutes passes and I hear the sound I hate the most, the sound of a mother who's lost her child. I look up and see that Dr. Chen has brought the patient mother to see the body of the son she tragically lost.*

 

No, it's never gets easier....and the day that is does, is the day I need to re-evaluate my own humanity.


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital

#108 A. Jones

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Posted 21 March 2019 - 02:01 AM

*We get to the hospital 10 minutes later and there are like 10 doctors waiting for us in the trauma room. We give our report, get our signatures, and go back to the ambulance.*
"M1 cleared" I say over the radio as we head back to the station.

Paramedic Ariana Jones

Shiloh County Fire Department

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#109 A. Jones

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Posted 21 March 2019 - 04:59 PM

--------------------Call Info--------------------

Incident #: 3/18/19
Department: SCFD
Address: 4519 South 7th

Dispatched As: Disturbance at Deli
First: Ariana Jones

Second: Erika Sjostrom
Other Agencies At Scene: Sheriff’s Department
 

--------------------Patient Info--------------------

Patient Name: John Doe

Date of Birth: Unknown
Age: Unknown
Patient Address: Unknown
Conscious or Unconscious: Unconscious
Trauma: Yes
Chief complaint: Burns

Signs & Symptoms: Burns, compromised airway
Past History: Unknown
Medications: Unknown

Interventions: Bilateral IO’s, 2 liters of saline given, 500 mg ketamine, intubated with 8.5 mm ET tube.

Transport or Refusal: Transport
 

--------------------Vital Signs--------------------

P: 155

RR: 12 (being manually ventilated)

BP: 60/40 (initial), 70/50 (after treatment)
Eyes: PEARRL

Skin: 3rd degree burns
Lungs: Stridorous

--------------------Narrative--------------------

Dispatched for a man acting erratically and talking about a fire. Upon arrival it was determine that there was in fact a fire. Fire department extinguished the fire and extracted the patient. Patient presented with 90% 3rd degree burns and was unconscious. Bilateral intraosseus access was obtained in the left and right tibias. 500 mg ketamine was administered for pain control and 2 liters of saline were administered according to parkland burn formula. Patient was intubated with a size 8.5 ET tube and manually ventilated via BVM at a rate of 12 breaths per minute. Patient’s O2 saturation improved from 70 to 95 and blood pressure increased to 70/50. Transported to Shiloh County Hospital.


Paramedic Ariana Jones

Shiloh County Fire Department

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#110 Dr. Grant

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Posted 22 March 2019 - 12:55 AM

I'm gowned up, and so is one of my 2nd year residents. The trauma team is is spread thin. We just had 2 other trauma's come in through the doors within the past 3 minutes, so instead of the residents running the show, I've had to step in to help out. This is a trauma alert, so the 4th year surgical resident is in charge of this one. We're just here to lend a hand.

 

*We all make small talk with the nurses and tech while we stand around waiting for the trauma to come in. Before we know it, our patient has arrived*

 

*Report is given and the patient is transferred over*

 

The pungent and penetrant odor of burnt hair fills the air. I've smelt a lot of repugnant and foul things in my career, but for some reason the smell of burnt flesh just does me in. Feces, gangrenous wounds, and the like are generally no more than an annoyance to my nostrils, but the sulfurous odor of burns just makes me sick. I try my hardest to hold it together.

 

*I evaluate the man's airway as my resident does a physical assessment as to the extent of the burns.*

 

'Hey. Sir. Can you hear me?' I ask as I see if I can get a response from him. His eyes do not open. He's unresponsive, and for his sake, I'm glad.

 

The trauma team tries to carefully remove his heat damaged clothing.

 

'Lungs clear bilaterally. Nothing audible over the stomach. Tube's good.' I say as I signal for the patient to be switched over to a ventilator.

 

*Nurses try in vain to find a suitable IV site. None is found, the burns are just too bad. He's going to need a central line.*

 

'I got 82% body surface area burns' my intern tells me. 

 

'I agree' the trauma resident replies confirming the assessment.

 

*They search for other injuries, but none are found. A chest X-ray is performed.*

 

His skin is a mess, with large pasty white/waxy  patches mixed among areas of eschar. What was left was red and inflamed. Some small patches of debris and clothing have literally fused to his skin, and will need to be removed by the burn team up stairs. With an 82% surface area burn, his long term chances of survival aren't favorable.

 

'Hey let's get him covered up really well', I say. He's visibly shivering, and without functional skin he can't regulate his body temperature. The last thing he needs is hypothermia, which is detrimental to all trauma patients. 

 

*After a few minutes of working on the patient, the surgical resident deems him stable enough to move. After swapping out the saline for lactated ringers, and ensuring that the man was adequately wrapped in blankets, he was rapidly transferred upstairs to the burn unit where the specialized team can give more definitive care.*

 

This was a simple case for us in the ER, but goodness knows this man has a long and painful road ahead of him...whoever this man is.


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital

#111 A. Breslin

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Posted 22 March 2019 - 05:49 AM

*After calling in a note enroute. we get a bed assignment. As the BLS driver walks around and starts unloading the stretcher we hop out of the back. I grab the back end of the stretcher and we walk into the ER towards the south side. We approach south 3 and I see Dr. Grant walking over to receive report. He seems a bit suprised to see me back so soon. I glance up and see the bag is a little under halfway done.*

 

'19 year old female. Septic, I hear the lifepak cycle for another BP. I'll give you the current BP in a second, Pulse is 132. o2 sat of 98 on a nasal. BGL of 63. Onset of 3 days. One 18 gauge in the Left AC with about 600 ML of saline.. I attempted a 16 on the other side but blew the vein. Pt has a Foley and most likely was a UTI that caused this.'

 

*We transfer the patient to the bed.*


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Paramedic Lieutenant Alyssa Breslin
EMS Duty Officer (EDO-1)


#112 Dr. Grant

Dr. Grant

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Posted 22 March 2019 - 06:22 AM

*I'm a little surpised to see Breslin back in action so soon.*

I knew she was a tough one.

 

*I refocus my attention on the situation at hand and hear the report, as the patient is being transferred over*

 

'What were her initial vitals?' I ask.

 

She's a relatively healthy (minus the whole sepsis deal)

'What is she catheterized for?'

 

*I approach her and get a general assessment.*

 

'Hey there, I'm Dr. Chris Grant, can you tell me your name?' I ask her. 'Can you tell me the year?'

 

'Do you have any pain anywhere?'

 

*I pull out my stethoscope and listen to her lungs and heart sounds.*

 

Regular rhythm, fast rate, no click, gallops, or rubs. Lungs are clear bilaterally.

 

*I look at the catheter bag. There is a small amount of lightly cloudy urine.*

 

'can you help me?' I ask the nurse who's in the room getting the patient's vitals. 'I want to flip her on her side real quick.'

 

*the nurse gets into position to help me roll the patient onto her side.*

 

'I'm going to roll you on your side to check your back, okay?' I tell her.

 

*She looks at me funny. She's definitely out of it. We roll her on her side.

 

I make a fist with my hand and firmly tap her left flank, then her right.*

 

She lets out a little moan as I tap her left flank.

 

*I begin feeling her back muscles.*

 

Her thoracic back muscles around T10-T11 are really tight. No rashes or signs of trauma.

 

*We roll her over back onto her back.*


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital

#113 R.Dunne

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Posted 22 March 2019 - 06:47 AM

*We transfer Aubrey onto the ER bed, and the doc asks what initial vitals were. Without even thinking, I answer him.*

 

'Her initial vitals were a heart rate of 138, SpO2 of 95%, respirations 34 with capno at 22 and a blood pressure of 98/53.'

 

*I rattle them off, watching the exam curiously and critically, my sister still looking very out of it. When the doc asks why she has a cath bag I answer him again.*

 

'She is paralyzed from the waist down, roughly, and has minimal bladder control. She also follows a bowel program.'

 

*I watch as Aubrey struggles to answer the doctor's questions.*

 

'I.. I don't know.. my..my whole body hurts.. who are you, what's going on...?'

 

*She looks confused and very disoriented to me, and I don't like seeing her like this. I watch at the doc does a bit more of a physical exam and her face wrinkles slightly in what looks like a grimace when the doc inspects her back.*



#114 Dr. Grant

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Posted 22 March 2019 - 07:41 AM

'What's the cause of the paralysis?' I ask as I lift her shirt to reveal her abdomen.

 

No abdominal distention or ascites.

 

*I place my hands and palpate her abdomen.* 

 

Soft. Non-tender, and no masses. Kidneys are not palpable.

 

*I find her pubic bone and press down just above it.*

 

No bladder distention or pain when pressing on the bladder.

 

'When was the last time she changed her catheter?' I ask as I start to move down to the groin area.

 

'Ok Aubrey, I'm just going to check your catheter, okay?' 

 

*I follow her catheter to its insertion point*

 

​No erythema or discharge around the urethra. 

 

'Temp is 39' the nurse lets out as she places the thermometer down and starts getting ready to draw blood.

 

'Does she have any medical problems? Allergies? Surgeries?' I ask Dunne.

 

'Is she up to date on immunizations? Do you know by chance?' I ask

 

*I grab her left leg, the one closest to me, and flex her hip to 90 degrees.*

 

Her leg is atrophied and flaccid, but that's not surprising since she's been paralyzed for so long.

 

*With her hip and leg flexed to 90 degree's I begin extending her lower leg, straightening her knee. Nothing happens. She does not lift her head off the bed or complain of pain in her neck.*

 

​Negative Kernig sign. Probably not meningitis.

 

'This may be a bit of a personal question, but do you know if there is any possibility she might be pregnant?' I ask.

 

This might seem like an odd question to ask, but it's important. Just because she's paralyzed doesn't mean a girl in otherwise perfect reproductive health can't be pregnant. It happens, and I need to know because it will dictate exactly what medications I give and what testing I run.

 

'Well what I'm seeing points really strongly towards an upper urinary tract infection, particularly an infection in her kidneys that's gone systemic. I'm going to check her blood and urine to confirm and see if I can figure out exactly what bacteria is causing this. Until then I'm going to put her on an antibiotic immediately and we're going to swap out that foley, since it's likely the source of the infection.'

 

*I pause for a second*

 

'She seems to be responding to fluids, but she's still septic. So for sure I'm going to admit her. Pending on the results, I'm going to confer with the internist who's taking her in and see if we want to do an abdominal CT to check her kidneys for an abscess, but we probably won't right away. Usually we try and treat the infection and if it doesn't go away within a few days then we image and check for an abscess.

She's in pretty serious shape but she has youth on her side, so I think we'll get her going in the right direction.'

 

*I pause again*

 

'One thing I need to explain is that once we start giving antibiotics, her condition may actually get a littler worse before it gets better. Once the bacteria that's circulating around her blood right now starts dying from the antibiotic, they release a bunch of bacterial junk, which can cause the immune system to overreact a bit. So there is always a risk of further deterioration once we start the antibiotics. So is it okay if we start the antibiotic therapy?'

 

'Do you have any questions or is there anything I can do for you right now?' I ask.

 

'Oh and your name is?' I ask Dunne. I shake his hand: 'I'm Dr. Chris Grant.'

 

'Well, sorry we had to meet under these circumstances but I think she'll be back in no time once we get these antibiotics going.' I say.

 

As I go to leave the room I look at the nurse.

 

'Lets keep her going on fluids and lets start Gentamicin. I'll enter it in right now' I tell her. She acknowledges and I leave the room, stoping at the first computer I encounter.

 

*I type up my assessment and enter my orders:*

 

CBC, serum Electrolytes, kidney function, venous blood gas, lactate, bHCG level. Urine analysis, culture, Leukocyte esterase, and nitrites. Remove and replace foley. IV Gentamicin, Normal saline.

 

'It's most likely a gram negative, probably E.Coli. Using Ceftriaxone would have been nice, but I'm not willing to risk an allergic reaction, despite the chance being pretty low.' I think to myself as I enter the order. 'Gentamicin will do instead.'

 

*I enter the order and log out*


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital

#115 R.Dunne

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Posted 24 March 2019 - 07:26 AM

'She was injured in an accident several years back. It caused an injury to T10.' 

 

*I watch somewhat curiously as the doc does his physical assessment. I don't often watch other providers, especially higher level ones, and I take the opportunities when I can; and it keeps my mind calm and not thinking about my sister. He asks me a couple more questions and I try to keep the answers as concise as possible.*

 

'I'm not sure when she changed it last - she is usually good at following her treatment instructions and she usually changes it every couple weeks. Besides the paralysis and associated issues she's healthy. She is allergic to penicillin and sulfa, nothing else. No surgeries. She does take gabapentin and tramadol; I'm not sure of the doses. I'm not sure about her immunizations. I am, however, fairly certain she isn't pregnant.' 

 

*As he finishes up his exam and asks if it's alright for them to do antibiotic therapy, I nod.* 

 

'Absolutely. I understand. I think I'm good on questions and I'll just.. hang out here until we know where she is going to.' 

 

*The doctor extends his hand and introduces himself and I meet his hand with a firm shake.* 

 

'I'm Rory Dunne. I wish we had met under better circumstances - I'm sure I'll be seeing more of you though.'

 

*I watch as he walks out and I take a seat in the room with a sigh. I know she'll be okay, I just hate waiting.*



#116 A. Jones

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Posted 24 March 2019 - 06:53 PM

*We get to the hospital and I give the report to the receiving nurse. I shoot a text to Captain LeBlanc telling him Kyle is okay and at the hospital. I really want to stay because I am worried about Kyle but work isn't over so I will come by if he is still here after the shift is over. If not I will see him at home*

"M1 Clear" I say over the radio and we drive back to the station.


Paramedic Ariana Jones

Shiloh County Fire Department

mpm.png


#117 A. Jones

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Posted 24 March 2019 - 06:53 PM

--------------------Call Info--------------------

 

Incident #: 22119

 

Department: SCFD
Address: South 4th St
Dispatched As: Structure fire
First: Ariana Jones
Second: Erika Sjostrom
Other Agencies At Scene: N/A
 

 

--------------------Patient Info--------------------

 

Patient Name: Kyle LeBlanc
Date of Birth: 02/19/1998
Age: 21
Patient Address:
312 Mountain Side Dr, Essex
Conscious or Unconscious: Conscious
Trauma: Yes
Chief complaint: Burn to right bicep
Signs & Symptoms: Burn
Past History: Allergies
Medications: Xyzal

 

Interventions: Irrigated burn with sterile water, wrapped with a cool, damp dressing, started an 18g iv in pts left AC
Transport or Refusal: Transport
 

 

--------------------Vital Signs--------------------

 

P: 87
RR: 15

 

BP: 125/83

 

Eyes: PEARRL
Skin: Warm, diaphoretic, pink
Lungs: Clear

 

--------------------Narrative--------------------

 

 21 year old male with a 3rd degree burn to the right bicep. Patient reports pain from said burn but refused pain medications. Burn was irrigated with sterile water, wrapped with a cool, damp dressing, and venous access was obtained via an 18 gauge to the left forearm. Patient was transported to Shiloh County hospital and report was given to receiving medical personnel.


Paramedic Ariana Jones

Shiloh County Fire Department

mpm.png


#118 Dr. Grant

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Posted 24 March 2019 - 07:19 PM

'How many patients is she covering?' I ask, a little annoyed.

 

'She's got this whole side of North.' the resident tells me.

 

*I sigh*

 

'I mean we can split it in half, you take one half of her section and I'll take the other half, at least until Dr. [director of the ER] and Dr. [Chief Resident] finds a better solution.' I say reluctantly.

 

'Yea, I guess we have no choice.' the resident replies, knowing that her work load just increased by 50%, along with mine.

 

One of our second year residents just went home sick. While I don't blame her, she was deathly ill looking, the whole situation means more work for everyone else involved.

 

'You take 1-7, and I'll take 47-41 plus 6 & 8, at least until we can get something else worked out. No new patients in this section until it's figured out.' I say. Luckily for us most of the patients in this section have already been seen and are either pending discharge, test results, or minor procedures. One needs sutures and the other a spinal tap. Luckily neither of those are mine.

 

*I look at my computer screen.*

 

I see one new patient was just added to ER room North 41...name: LeBlanc, K. he's the last one.

 

I proceed to flag the other rooms in question as unavailable for new patients as the unit clerks starts phoning triage and ambulance reception to tell them of the temporary measure. By the way the conversation is going, neither sound too happy about it.

 

*Re-focusing my attention on my current case list I see that patient Dunne, A. has lab results ready to view. I open the lab results, and everything is as I expected*

 

White blood cell count 19,000, elevated lactate Urine leukocyte esterase is positive, White cell casts found on microscopy of urine. Electrolytes are more or less fine, but kidney function looks a tad decreased. No surprise there. 1+ hematuria.

 

I've seen enough to call it. This girl has classic pyelonephritis.

 

*I type up my assessment and complete my admission note*

 

Patient being admitted for sepsis secondary to acute pyelonephritis.

 

*The phone rings, and the clerk answers it*

 

'Dr. Said on the phone for you, Dr. Grant.' The clerk tells me.

 

*I pick up the phone*

 

'Hey Dr. Said it's Dr. Grant down in the ER. How are you doing?' I say trying to establish a good rapport before I ruin his day with another admission.

 

'What do you got for me?' he asks in a light arabic sounding accent. He wastes no time on pleasantries. Who was I to kid? A hospitalist is getting a call from the ER...he know's he's getting another admission.

 

'Hey so I have a 19 year old female, who came in by ambulance for altered level of consciousness...' I deliver my report, stating that I've started her on fluids and gentamicin and that she is stable. I then relay the lab findings.

 

'Yes, it's urosepsis and pylo. Alright, just continue what you have, and I'll take a look at the chart and see her when she gets up here.' he tells me.

 

He hangs up.

 

*I finish my note, and log out of the computer. I then proceed to the patient's room.*

 

*Walking into the room I knock on the door way*

 

'Hey there, so the results are back and it looks like she has a urinary tract infection that's progressed up to her kidney, causing sepsis.' I say.

 

'So I'm going to admit her to the general internal medicine ward. She's going to be seen by Dr. Said, one of our hospitalists and he's going to probably continue the antibiotics and monitor her condition until everything is resolved. We'll get her moved upstairs as soon as we get a bed assigned to us, but just from how things work around here, it can be up to an hour from now.' I say realistically.

 

*I pause for a moment before asking my standard line*

 

'Do you have any questions, or is there anything else I can do for you?'

 

With everything said and done, I shake Dunne's hand. I see that Aubrey is sleeping, so I forgo saying goodbye to her.

 

'She'll be taken good care of.' I say exit the room in reassurance.


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital

#119 K. LeBlanc

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Posted 24 March 2019 - 07:34 PM

*After they drop me off in the hospital, I get wheeled back to one of the bays in the back.  Lovely.  I'm right next to the bathroom too.  Terrific.  I sit in the bed with my phone still in hand as I text my parents.  Both of them are working, but just to let them know where I am...  Of course I don't how to describe where I am other than to say "a room made of curtains".  I sigh and I wait.  They come over hand take another set of vitals again, which whatever.  No big deal.  I still haven't really seen the burn itself.  I can see the edge of it, but I'm curious.  I'm also curious how turnout gear failed me that badly.  I decide to take my phone and flip it around so that I can use it like a mirror to see the burn.  I check it over.  Yeah.  Gnarly.  I sigh before I put my phone down and wait for someone to come in.  There seems to be all kinds of people in here and I have no idea what is going on, but I'm at the mercy of the hospital system right now.  In clothes that are probably full of carcinogens.  I do have to laugh to myself.  I can only imagine trying to get a CT scan with all of the metal in my pockets.  That'd be interesting.  While I'm sitting in the bed, I start looking for news about the fire.  For something that big, I'm sure that the news picked it up or the facebook reporters got something.  I'm sure the bottom will read "a firefighter was injured too."  The news always wants to mention that but never follows through.  Lovely.  I keep scrolling and searching, trying to occupy my time.*


Firefighter Kyle LeBlanc
Truck 7

Ex. Kimberly Volunteer Fire Department Member 730, Ex, SCFD Volunteer


#120 Dr. Grant

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Posted 24 March 2019 - 08:22 PM

Okay, lets take care of the new patient. Once I get him situated then this whole extra section should more of less be on autopilot.

 

​*I check out the triage note on him to see what I'm getting myself into.

 

I read for a bit, then log out and proceed to the room. I stop at a wash basin in the hallway and wash my hands before continuing towards the room.*

 

Firefighter burned while fighting a fire, one of the many reasons why a career in the fire service was never on my radar.

 

*I knock on the doorway before pulling back the curtain to enter the room.*

 

'Mr. LeBlanc?' I say as I knock.

 

*I enter the room and close the curtain behind me. I nab a little hand sanitizer and proceed over to the patient. I see he's wearing turnout pants still. This man's straight off the fire scene.*

 

'Hey I'm Dr. Grant, one of the Emergency doctors here.' I say as I pull a roller stool from the corner of the room and have a seat in front of him.

 

'I saw in your triage note that you got burned on a structure fire. Is that what brings you in? What happened?' I ask.


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital




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