Jump to content


Photo

Emergency Department


  • Please log in to reply
129 replies to this topic

#121 K. LeBlanc

K. LeBlanc

    Firefighter

  • Engine
  • 185 posts
  • Character Hometown:Cumberland Ridge, Kentucky

Posted 25 March 2019 - 01:46 AM

*As the doctor comes in, I put my phone down and I look up at him, still with my T-shirt wrapped up like a tank top on the one side and my tactical shirt across my lap.  When he asks about what happened, I figure that I'm going to make a joke out of it.*

 

'Well you see there was this fire...  And they're hot...'

 

*He's not laughing.  Serious dude.  Okay.  Two can play it that way.*

 

'Nah, what really happened was a compression burn or whatever.  I hit my shoulder against a door frame and it took the air gaps out of my gear and the heat burned me.  Or something like that, I dunno.  The turnout gear class doesn't teach shit here.'


Firefighter Kyle LeBlanc
Truck 7

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


#122 Dr. Grant

Dr. Grant

    EMS Physician

  • EMS


  • 56 posts
  • Character Hometown:Reno, NV

Posted 25 March 2019 - 03:28 AM

He seems to be in good spirits, that's good.

 

'Oh wow, I never knew it was just that easy to get burned through all that equipment.' I say legitimately astonished, 'Forgive me though, I'm completely ignorant to how most of the protective equipment works and what the weaknesses are. Eitherway...I'm sorry this happened, I'm sure the last thing you wanted to do today was be here today.' 

 

'Anyway, lets take a look at this thing.' I say as I get up from the stool.

 

*I see a loose cover over the right upper arm.*

 

That must be it.

 

'Is it your right side?' I ask as I move to the right arm. He confirms.

 

*I put on a pair of gloves and carefully start removing the cover over the burn area.*

 

'What's your pain level like?' I ask. 'On a scale from 0 to 10? 10 being unbearable.'

 

The cover comes off, revealing the burn. The whole thing is about 6cm in diameter, probably a little bigger than the palm of a hand. The core of the burn, which is the worst part is pale and almost waxy looking, with dark spots intermingled with it. It measures about 2-3cm. Around the central part of the burn is a larger area of red, raw looking flesh with curled thin peices of singed skin scattered about. It looks like they're starting to form tiny dew-drop like blisters.

 

How is he not in pain? He's probably still running on endorphins or adrenaline. The central part is definitely looking like a mix of deep dermal and full thickness, while the outer edges are partial thickness (2nd degree) fading out to superficial (1st degree) burns. He must be still running on either adrenaline or endorphins. While the full thickness burns typically don't hurt, the surrounding second and first degrees typically do. He's a tough guy, but I'm sure being exposed to open air right now isn't good feeling.

 

'Well....you got yourself pretty good here.' I say.

 

'Is this the first time you've ever gotten injured on the fire ground?' I ask trying to distract him a bit.

 

*I press on the inner portion of the burn. The central area does not blanch, it stays the same color. The outer area does blanch a little. He flinches.*

 

'Sorry about that.' I say as I continue.

 

Central portion is more than likely full thickness, outer edges are not. Lucky for him this is mostly 2nd and 1st degree

 

'You were wearing you full protective equipment? Your BA?' I ask.

 

'So you got burned, and were able to get out of the structure on your own?' I ask trying to make sure I understand the whole situation.

 

'You didn't get hit with debris, ot get knocked out or anything?'

 

*I begin checking his pulse in the burned arm and the uninjured for comparison.*

 

Good strong pulse. No vascular compromise. That's good.

 

*I grab a cotton swap out of on of the drawers in the room*

 

'Okay, close your eyes for me.' I say. 'Now I'm going to lightly touch you at different spots on your arm. Just tell me where i'm touching when you feel it.'

 

*With his eyes closed I begin touching the middle aspect (unburned) of the burned arm, then his outer and inner forearm and the palm and dorsum of his hand. I conclude with an unburned portion of the outer upper arm just below the burn injury. He is able to correctly and immediately identify each spot I lightly rub with the cotton tipped applicator swab.*

 

Good, neuro is intact.

 

*I place two of my fingers into the palms of both of his hands.*

 

'Okay now squeeze my fingers' I say

 

*I flex his lower arm to 90 degrees and have him pull towards him and push away. Both appear to be at least a little painful, probably because of the tension the contracting muscles are putting on the burnt skin.*

 

Good motor strength. I'm not worried about a compartment syndrome. Things are not looking too bad.

 

'Are you breathing okay? No coughing? You didn't inhale any smoke or get any fire or extreme heat in your face did you?' I ask as I reach for my stethoscope. 

 

*I have him take some deep breaths as I listen to his lungs*

 

All clear.

 

*I listen to heart sounds.*

 

Regular rate and rhythm. 


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

#123 K. LeBlanc

K. LeBlanc

    Firefighter

  • Engine
  • 185 posts
  • Character Hometown:Cumberland Ridge, Kentucky

Posted 25 March 2019 - 07:04 AM

*When he apologizes that I'm there, I nod.*

 

'Yeah, thanks.  First good fire that I get to go inside on in a few years actually and I end up getting burned.  I guess I lost some of my badassery playing mathematician at the engine.'

 

*When he asks if it's my right side, I nod.  I guess the sleeve rolled all the way to my shoulder isn't enough, but he's going his job.  I get it.  When he asks what the pain level is, I take a second before I answer.  Part of it is to figure out what the number is also also part of it is for me to figure out if I want to say it.  I'm not one for pain meds, but It's not the most pleasant.*

 

'I dunno.  It's at least a 5.  Probably like a 6 I guess.'

 

*I try and look over as he's doing his examination.*

 

'Yeah this is the first time I've had to go to the hospital, that's for sure.  Like I said, I haven't been in that many fires before.'

 

*Right as I finish, I look back straight again when he starts poking me like a lab rat, but it's his job so I get it.  When he hits near one of the blisters, I eyes go wide as I let out a short grimace.  He apologizes and I shake it off.  When he asks about my "BA" and all of my gear, I laugh.*

 

'The only person I've ever heard the term BA from was a retired Navy guy.  But yeah, I had all of my gear and my airpack on.  Otherwise, I'd probably be unconscious.'

 

*I try to chuckle just to lighten the mood.  He then asks about getting out of the building.*

 

'Yeah I mean all I did was run into a door frame.  I got out fine.  All it was was crawling to the ladder and coming out of the sill.'

 

*Next is the head injury question.  Figured.*

 

'Nah, just the damn door.  Structurally it seemed like it was good while I was in there at least.  I am curious as to what the hell was burning in there.  That thing was took off while I was in there.'

 

*As I start getting swabbed this time, I start calling out where he's hitting me.  Of course it's basically 'upper arm, forearm, and hand' but message received I guess.  I then do basically the same thing that I've had to do with the department physicals.*

 

'Nope breathing's fine thanks to the good people at Scott.'

 

*I reference the air pack distributer as he checks my lungs and then my heart.  I sit back and wait for what he's got next for me.  Hopefully he can do whatever he needs to do and let me go.  Main thing I know about burns is cool water and time to heal.*


Firefighter Kyle LeBlanc
Truck 7

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


#124 Dr. Grant

Dr. Grant

    EMS Physician

  • EMS


  • 56 posts
  • Character Hometown:Reno, NV

Posted 25 March 2019 - 11:42 PM

*I smile at some of his answers, but try and keep things moving*

 

*I ask about his past medical history, allergies, and ask about any prior hospitalizations or surgeries.*

 

Nothing, except for a history of sinusitis.

 

*With my physical exam complete, I begin explaining my findings*

 

'Alright, so the burn on your arm does indeed have a central part that is full thickness, or third degree, but the majority of it..'

 

*I start to gesture around the burn*

 

'...is all partial and superficially burnt, meaning they will heal just fine on their own. This full thickness part, unfortunately, will not heal on its own unless a skin graft is performed...otherwise it just scars over.

 

Unfortunately your particular burn is too large for me to make the call as to whether we just let it scar over or if a skin graft is warranted. So what I want to do is call one of our burn specialist surgeons down to take a look, and he or she can give you a definitive answer as to what the best course of action is going to be in your particular case. I will say that from my personal experience with similar cases, the surgeon will probably recommend a skin graft, especially given it's location.'

 

*I pause for a moment before continuing*

 

'As far as everything else is concerned, you're in good shape. It's pretty localized and your strength and sensations are all good, but I do want to give you a tetanus booster. It's pretty much standard practice that every burn patient gets a tetanus booster, unless they've had one within the last year....Have you?'

 

After I get my response I continue on my long winded rant:

 

'Okay. Before I go, I just want to take a second to kind of give you the low down on what's probably going to happen. As you probably have noticed, we're a bit busy in here tonight, so. I honestly don't know how long it's going to take for the surgeon to come and see you. If they're not busy they can be here pretty quick, but my guess is that's not likely. So instead of having you stew in here just wondering without a clue as to what's going to happen...I'd like to offer you what I think will probably happen based on similar cases I've seen.'

 

'As I said before, they're going to probably recommend the skin grafting or some similar procedure. However, the good thing is I can almost guarantee you'll be going home today. The surgeon will clean the burn, get rid of all the dead skin and debris, and bandage it up with antibiotic dressings. They'll let you go home and follow up again in the clinic with them within the next 2 to 3 days to talk specifics if a procedure is warranted.' I say.

 

*I pause, and get up from the stool*

 

'Can I offer you some medication to take the edge off of any pain you have? Or are you doin' alright?' I ask. 

 

He seems to be doing okay, at least based on his demeanor. If he refuses, I hope the surgeon can at least convince him to accept a short-acting pain killer before they debride the wound, because that is a very painful process.


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

#125 K. LeBlanc

K. LeBlanc

    Firefighter

  • Engine
  • 185 posts
  • Character Hometown:Cumberland Ridge, Kentucky

Posted 26 March 2019 - 02:45 AM

*Shit.  Here comes the skin grafts.  Lovely.  When he asks about tetanus, I shake my head.*

 

'Nope.  I got a booster 2 years ago.'

 

*When about waiting longer in the hospital, I shake my head.  Figures.  I mean I can't blame them, but Every time I've ever been to a hospital or known someone in a hospital, it's been a delay.  Now that I'm getting a surgeon's opinion, I guess it's more serious than I thought.  I mean it never did look good, but still.  When he asks about any medication, I shake my head.*

 

'Nah, I'm good for now.  I definitely want something though when they go to do whatever though.  I've heard that sorry story before.'

 

*He finishes up with me and heads out as I pull out my phone and update my parents.  I think for a second before I flip over to Ariana's text thread.  Once I finish sending her the message, I look down at my legs for another minute.*

 

'Shit on this.'

 

*I carefully get up, careful to avoid hitting anything or messing with any of the IV tubing.  I carefully work my bunker pants off so that all I have on is my station pants.  I set them up like normal, except now with the suspenders between the boots before and I put them on the foot of the bed with my legs going off to either side while I wait for the next person to come in and tell me what I need to know.*


Firefighter Kyle LeBlanc
Truck 7

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


#126 Dr. Grant

Dr. Grant

    EMS Physician

  • EMS


  • 56 posts
  • Character Hometown:Reno, NV

Posted 26 March 2019 - 05:00 AM

After exiting the room I proceed to the nurse's station and hop onto the computer and start typing up my note.

 

*I look at the clerk*

 

'I need a burn consult for room 41, would you mind paging them for me, please?' I ask as I continue typing my note.

 

She gives me a little bit of a look and then picks up the phone.

 

I continue about my work. I finish my note on the last patient and start looking at my others. I go and examine another patient and return about 8 minutes later. As I'm writing up my note for that patient my hospital-issued VOIP phone rings.

 

*I pull it out of my coat pocket and answer it*

 

'ER, Dr. Grant' I say.

 

A sweet, young female voice replies on the other side.

 

'Hey Dr. Grant, this is Dr. Romano, I heard you have a patient that needs a burn consult?' she replies.

 

She sounds....cheery....not like your typical surgeon. Usually when I ask for a consult I get attitude and passive-aggressive undertones. Ok...maybe not all the time...but it seems to happen all the time. Everyone hates the ER doctor...all he does is give everyone else more work.

 

'Hey Dr. Romano, yes, I have a 21 year old male firefighter who was burned on the job. He's got a localized, well circumscribed, thermal burn about 6cm in diameter on the lateral aspect of the right upper extremity. It looks to be mostly partial thickness but it has a central area of full thickness burn about 2cm wide....' I continue and give her the run down on the patient.

 

'[Sigh], okay...I've got a couple consults ahead of him, it seems like everyone decided today was a good day to play with chemicals and hot things. We're swamped up here. I'll be down as soon as I can, but I have to warn you, it might be a while.', she continues, 'How's his pain level?' she asks.

 

'He's a trooper, I'll give him that. Not a single drop of analgesics since he's been here. He seems to be handling it well.' I reply.

 

'Okay, well....I'll be down to see him as soon as I can.' She says.

 

'Thanks for your time.' I reply. We say our goodbyes and I hang up.

 

*I continue my work.*


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

#127 E. Sjostrom

E. Sjostrom

    EMT

  • EMS
  • 853 posts
  • Character Hometown:Washington D.C.

Posted 19 April 2019 - 11:04 PM

*Pulling up the loading area of the hospital I come to a stop and hop out of the truck after putting M2 in park.  Walking to the back I help Miller unload the stretcher with the patient on it and bring him into the ER.  As we get inside I hand off the PCR to one of the nurses.*

 

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

Incident #: 03282019
Department: SCFD-EMS
Address: Meadowlark High School, Oxnard
Dispatched As: Brawl
First: E. Sjostrom
Second: L. Miller
Third: n/a
Other Agencies At Scene: SCSD
 

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

Patient Name: Steve Clarkson
Date of Birth: 2/21/2003
Age: 16
Patient Address: 13 September Street, Oxnard
Conscious or Unconscious: Conscious
Trauma: Yes
Chief complaint: Stabbed in the side of the chest
Signs & Symptoms: Open gash, Hemorrhaging from left side of chest
Past History: None
Medications: None
Interventions: 4x4 gauze, tape
Transport or Refusal: Transport


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

P: 128
RR: 22
BP: 110/68
Eyes: PEARLL
Skin:
Lungs: Clear

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

M2 dispatched to Meadowlark High School in Oxnard for a patient stabbed during a brawl.  Upon arrival school staff led us to patient lying on the floor of the hallway.  Patient was bleeding out from the left side of his chest.  Vitals were taken and 4x4 gauze were used until bleeding was stopped.  Used tape to cover the gauze and then we transported patient to Shiloh County Hospital.


memt.png

EMT Erika Sjostrom

Medic 3


#128 E. Sjostrom

E. Sjostrom

    EMT

  • EMS
  • 853 posts
  • Character Hometown:Washington D.C.

Posted 20 April 2019 - 06:52 AM

*We arrive at the hospital and as we come to a stop I open the door and help both Jones and Abboud out of the back of the truck.  As we bring them into the ER I hand over the PCRs to one of the nurses and head back to M2.  After moving Miller back to the passenger seat I get in the driver's seat and head to the station.*


memt.png

EMT Erika Sjostrom

Medic 3


#129 A. Jones

A. Jones

    Paramedic

  • EMS
  • 172 posts
  • Character Hometown:London

Posted 22 April 2019 - 03:34 PM

*I am sitting in the hospital bed when a scared looking doctor come in…at least I think he is a doctor*

‘So what seems to be the problem today?’ He asks me

‘My partner got shot, I can’t hear’ I reply

‘Okay well I’ll just take a look at you okay?’

*The sort of doctor begins doing an oddly thorough exam*

‘Okay so I think you have acoustic neuroma, you need to get a CT scan’ he says as another doctor walks in and calls him a moron.

‘Did you even do a neuro exam… she doesn’t have acoustic neuroma you idiot.’ The new doctor says ‘It’s just tinnitus, it should go away on its own. You will be fine’ The new doctor tells me

‘Okay thank you. Can I go now?’ I ask

‘Yep you are free to go’ he tells me


Paramedic Ariana Jones

Shiloh County Fire Department

mpm.png


#130 Dr. Grant

Dr. Grant

    EMS Physician

  • EMS


  • 56 posts
  • Character Hometown:Reno, NV

Posted 03 August 2019 - 06:52 PM

*I walk briskly down the hallway and enter ER South. I have an annoyed look on my face. Barging into the room I make my way towards the nurses' station, my target in sight.*

 

"Dr. Wayne." I say firmly as I approach. The young intern abruptly stops conversing with the even younger looking medical student next to him and looks at me. I'm certain he notices the look on my face.

 

*I stop in front of him*

 

"So I just went through the charts, and it seems that you're 3 whole days behind in charting. I've got multiple people breathing down my neck about it, and I'd really appreciate it if you got caught up." I say in an annoyed voice.

 

*There is a brief silence*

 

"I'm sorry Dr. Grant, I've just been so busy..."

 

*I cut him off*

 

"Well, not anymore. I need you to get caught up...and until you do, I don't want to see you in here."

 

*His bewildered face looks back at me, as if to ask 'are you serious?'*

 

"There's an empty office in ER administration that you can use...away from the distraction." I say.

 

*His face shows disappointment with a hint of anger.*

 

"Okay," he says softly. "Lets go." he tells the medical student.

 

*I look at the student. He looks confused about what he got caught in the middle of.*

 

"That won't be necessary." I say. "There's no reason the student needs to suffer for your inability to stay on top of your work..."

 

*I get a dirty look in return from Dr. Wayne. It doesn't bother me.*

 

"Come with me." I say to the student as Dr. Wayne turns and walks out of the room.

 

*I look around and notice the clerk and a couple nurses staring and then immediately returning to work when they notice me look at them. They smile while whispering to themselves about the scene they just witnessed.*

 

"What's your name?" I ask the medical student as we walk over to trauma. "George Hoff...third year."

 

"Well, George Hoff, third year, what is it you want to do in medicine?" I say as I approach the trauma nurses' station. I start fumbling on the computer.

 

"Well...I'm really interested in cancer research. I'm actually an MD/PhD student." he says proudly.

 

"Cancer research, huh? ...well I got the next best thing for you...a rectal bleed." I say as I see the case on the computer.

 

"Ever done a rectal exam?" I ask him. He shakes his head.

 

"Well today...is your lucky day." I say with a smile on my face. The first rectal exam is a rite of passage for any medical student.

 

*His eyes get wide*

 

"Dr Grant." A nurse says as she walks into the trauma area. "We have an MI turned full arrest coming in..with an ETA of 1 minute...Trauma 1" 

 

"Well, it looks like you just earned yourself a stay of execution there, Dr. Hoff." I say as we make our way to trauma 1. 

 

"What's the first drug given for a patient in ventricular fibrillation" I ask the student as I get ready for the patient.

 

He pauses...thinks for a moment..."Oxygen?"

 

"1mg Epinephrine IV Push with a repeat every 3-5 minutes...what's the second drug?" I ask.

 

"Oxygen." He says confidently.

 

"Amiodarone 300mg IV push with a 150mg repeat every 3-5 minutes " I say. "When he comes in, I want you to do compressions."

 

He gives me a look of fear.

 

"Relax....hands in the center of the chest...and you push....and once you've finished pushing...you push again." I say as I start to organize the team.

 

The patient comes in, paramedics are bagging him. No tube in place. The patient is a large heavy-set man in his 50s. He has ECG patches and defibrillator pads on him. IV is in place but no tube. The paramedics explain that the patient had a confirmed MI on the 12-lead ECG. Further, they explained that he lost his pulse during transport, but quickly got it back with defibrillation. 

 

The patient is moved to the trauma bed, and we begin our assessment. The paramedic's monitor immediately starts to alarm as his heart rhythm goes back into VFib. The paramedic starts compressions again as a tech transfer's the patient to the hospital defibrillator and monitor. The patient is blue around his lips, but appears to be muttering something. Dr. Hoff, the medical student, leans in to hear what the man is saying. 

"I love you Abbey...I love you Abbey.." he whispers before he goes unconscious. 

 

"Lets charge to 200. I say." The defibrillator charges. "What did he say?" I ask student doctor Hoff. 

 

"I think he said...'I love you Abbey'." he replies.

 

"Everyone stand clear." I say as the patient gets shocked.

 

"Dr. Hoff, get on those compressions." 

 

He hesitates, but after some coaching starts doing compressions well.

 

------

 

After a 20 minute resuscitation, we fail to get the patient's heart rhythm back. I make the call. Time of death 13:31.

"Is there any family in the waiting area?" I ask. 

 

"Yeah. There's a whole crew out there. They're in the first family waiting room" a nurse says. 

 

Dr. Hoff looks disheveled. His tie is loosened, the top button undone on his button up shirt, his hair is a mess, his short white student coat on the counter in the corner.

 

"Well, Dr. Hoff. Now we get to do my least favorite part of the job....Delivering bad news. Let's go." I say to him.

 

As we walk down the long hall to the private family waiting room, he tries his best to fix up his appearance.

 

*We arrive at our destination. I knock on the door and we both enter. The room fairly full. It looks like there are a lot of family/friends in here waiting.*

 

A woman comes forward, a man holding her. She looks distraught already.

 

"Are you the Benitez family?" I ask. The woman fighting back her tears replies that she is the patient's wife, and that the man holding her is her brother. I look around. There are about 12 people in the room in total. 

 

"I'm Dr. Grant, the attending physician who saw your husband when he came in earlier....I'm sorry to say that your husband had a massive heart attack.."

 

*The patient's wife begins to cry, he brother holds her tightly.*

 

"..and despite our best efforts, the damage to his heart was too much and we were unable to save him. I'm so sorry to say that he is dead....I'm sorry for your loss."

 

*The patient's wife loses it and buries herself into her brother. Everyone else in the room begins hugging and looking sad. Sniffles start to fill the room.

 

Suddenly, Dr. Hoff says something to the patient's wife:

 

"I just want you to know...that your husband was thinking of you in his final moments." he tells her.

 

The patient's wife composes herself enough to ask Dr. Hoff a question in reply.

 

"What...what did he say?" she says struggling to put a smile on her face.

 

Somberly, Dr Hoff replies: "He said...I love you Abbey."

 

The patient's wife's looks back confused.

 

"...but my name is Michelle.." she says confused by this statement. "Abbey is Johnny's wife" she says as she looks to the back of the room. Everyone in the room looks at a larger woman in the very back. Her eyes grow wide.

 

*Complete silence falls upon the room for a moment. Suddenly there are a few gasps. *

 

"THAT BASTARD!" the wife lets out in anger. She begins to yell incredibly angry things.

 

*I perform a partial facepalm and transition into giving an incredibly dirty look to Dr. Hoff for making this mess of a situation.* 


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




0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users