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Dr. Grant

Member Since 21 Aug 2017
Offline Last Active Today, 03:51 PM
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Posts I've Made

In Topic: Emergency Department

Yesterday, 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*

 

‚ÄčNo 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.*

 

‚ÄčNegative 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 Ceftriaxone and Sulbactam. 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 Ceftriaxone-Sulbactam, Normal saline.

 

'Ceftriaxone should be good enough. It's most likely a gram negative, probably E.Coli.' I think to myself as I enter the order.

 

*I enter the order and log out*


In Topic: Emergency Department

Yesterday, 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.*


In Topic: Emergency Department

Yesterday, 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.


In Topic: Dr. Grant's Home

18 March 2019 - 07:43 AM

*I enter the house through the garage. It's around 5p. The home alarm can be faintly head giving a couple beeps in the distance notifying that the door has been opened. I can hear the kitchen sink running.*

 

Nicole: 'Is that you babe?'

 

Me: 'Nope. Don't mind me. I'm just an intruder here to rob you out of house and home.'

 

*I close the door behind me and make my way to the kitchen*

 

Nicole (Jokingly): 'Oh really? Well my husband's stuff is upstairs.'

 

*Nikki is washing something in the kitchen sink. Her back is to me. I put my backpack down on the counter and sneak up behind her and wrap my arms around her body.*

 

Me: 'I have not come for that. I've come for you.' 

 

*She giggles a bit*

 

Nicole: 'Oh brother.'

 

*I give her a little kiss and release her and go back to the counter to grab my backpack.*

 

Nicole: 'So how was your day?'

 

Me: 'Well...only 30 patients in 10 hours. So...typical. How about you hun?'

 

*I make my way to the living room*

 

Nicole: 'Not bad. Typical mom day. Cleaned...chased the ferrel children around...cleaned some more.'

 

*I enter the living room and see Courtney watching an animated TV show on the TV. She turns around and sees me. her eyes light up and she gets up and runs towards me. I put a huge exaggerated smile on my face as I see her come towards me.*

 

Me (To Nicole): 'Sounds exhilarating'

 

Courtney: 'Daddy!'

 

*Courtney gives me a big hug. I hug her back....and just as quickly as the hug came, she was over it. She let go and went back to her TV show. I look around the room.*

 

Me: 'Where's Adam?'

 

Nicole: 'Oh..he was really fussy. he's upstairs taking a nap...or tearing his crib apart...one or the other.'

 

*I laugh...oh he's a devil baby sometimes. I turn back around. Nicole has finished and leans against the kitchen counter to talk to me.*

 

Nicole: 'So...our loans are due.'

 

*Ugghh...Loans. While mine makes up the vast majority, between the two of us we owe as much as a home to the federal government still for our educations. I can only thank the lord that I only need to pay for 4 more years before the balance is forgiven.*

 

Me: 'So we're going to put $2,000 on yours, $6,000 on mine, and $1,100 for the house?'

 

Nicole: 'Yeah, that's what we talked about right?'

 

Me: 'Yea. This is the most painful experience of my life. I worked my butt off this past month working extra and here it all goes, with one click on the computer.'

 

Nicole: 'Hey..4 more years.'

 

Me: 'True that' 

 

*I go have a seat in the living room near Courtney. She's watching the TV show intently, not even noticing me there. It's something about an amphomorphic pink hippo. I sit there quietly for a moment. Nikki comes over and has a seat next to me on the couch. I look over at her with a stupid look on my face.*

 

Me: 'So what if I was to take that loan money and go to Acey Beach and bet it all on black?' (Acey Beach being a near by Indian casino).

 

Nicole: 'I'd probably say you had Bipolar one and were in acute mania.....then I'd have to shoot you.'

 

Me (With a big smile on my face): 'Are you diagnosing me?' 

 

Nicole: 'Hypothetically'

 

Me: 'Hypothetically?'

 

Nicole (Trying to hold a serious face): 'For real.'

 

Me (smiling again): '..and you'd shoot me?'

 

Nicole (smirking): 'Yeah. Probably.'

 

Me: 'Wow.....it's a tempting offer.'

 

Nicole (smiling): 'Shut up'

 

*She slaps my shoulder jokingly.*

 

Me (sarcastically): 'Ah abuse...ah....no more...police...help..'

 

*I fake struggle to get up, getting up eventually.  I've got to get out of these dirty work clothes.*

 

Nicole: 'Oh babe, check on Adam for me and make sure he's not tearing up his crib. I just spent half the day cleaning that room.'

 

Me: 'Got it. Oh...and dinner? Chinese? Grub Hub?'

 

*I start making my way up the stairs.*

 

Nicole: 'Yea that's fine....but no spicy!'

 

*I make my way to the top of the stairs*

 

Me (Jokingly): 'Oh stab a knife through my heart will ya?' 


In Topic: Emergency Department

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.