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#58766 Emergency Department

Posted by Dr. Grant on 22 March 2019 - 07:41 AM in Shiloh County Hospital

'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*

#58760 Emergency Department

Posted by Dr. Grant on 22 March 2019 - 06:22 AM in Shiloh County Hospital

*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.*

#58748 Emergency Department

Posted by Dr. Grant on 22 March 2019 - 12:55 AM in Shiloh County Hospital

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.

#58605 Emergency Department

Posted by Dr. Grant on 18 March 2019 - 04:30 AM in Shiloh County Hospital

"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.

#58804 Emergency Department

Posted by Dr. Grant on 24 March 2019 - 07:19 PM in Shiloh County Hospital

'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.

#58806 Emergency Department

Posted by Dr. Grant on 24 March 2019 - 08:22 PM in Shiloh County Hospital

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.

#59069 Emergency Department

Posted by Dr. Grant on 03 August 2019 - 06:52 PM in Shiloh County Hospital

*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.* 

#58820 Emergency Department

Posted by Dr. Grant on 26 March 2019 - 05:00 AM in Shiloh County Hospital

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.*

#58817 Emergency Department

Posted by Dr. Grant on 25 March 2019 - 11:42 PM in Shiloh County Hospital

*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.

#58812 Emergency Department

Posted by Dr. Grant on 25 March 2019 - 03:28 AM in Shiloh County Hospital

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. 

#58467 Emergency Department

Posted by Dr. Grant on 16 March 2019 - 07:24 AM in Shiloh County Hospital

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?'

#58555 Emergency Department

Posted by Dr. Grant on 17 March 2019 - 05:44 PM in Shiloh County Hospital

*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...

#58357 Emergency Department

Posted by Dr. Grant on 15 March 2019 - 01:19 AM in Shiloh County Hospital

I feel for her. How is one supposed to feel after a crappy situation like this?


'Yeah, no words are really necessary right now. I imagine you're still just processes this whole thing. I can't even begin to imagine what must be crossing your mind.' I say. 'Is this the first time time you've ever been in this situation?' I ask.


I start listening to her lungs and instruct her to take deep breaths.


Lungs are clear.


I place my stethoscope on her chest and start listening to heart sounds. 


A little fast, but normal sounding.


'Any aches or pains? Cuts, scratches?' I ask as I check the pulses in both her wrists.


'Any dizziness, shortness of breath?' I ask as if programmed to ask those questions.


I take a peek around to her back to make sure there's no bleeding or anything I'm missing.


'Just to be clear, you were not physically assaulted or actively shot at right? I only ask to make sure I'm not missing any injuries.'

#58355 Emergency Department

Posted by Dr. Grant on 15 March 2019 - 12:55 AM in Shiloh County Hospital

I get up from the computer at the nurses' station after filing a long note on the last patient I just discharged.


We're busy, as usual, but we have a couple of open beds. The MI I had has been sent up to cath lab and is no longer my responsibility, the asthma attack patient seems to be doing pretty well now, and my 48 year old weekend warrior tackle football player is just waiting on the orthopedic surgeon to show up and chastise him for leading shoulder first into his tackles.


I take advantage of this rare chance to get up and stretch my legs and go for a quick stroll out to ambulance reception. I see 2 crews waiting to enter the psych ER and one crew checking in with the triage nurse. The triage nurse looks annoyed, but is nevertheless typing up the EMS crew's report. I walk over to see if this is possibly heading my way.


As I approach I see that both of these 'patients' are in uniform. My interest is sparked immediately. I stand nearby and overhear the report. They're just finishing up. The triage nurse has the patients take seats in some chairs against the wall until she 'can find a place for them'. A young (probably not a day over 18 years old) man in dark slacks and a white polo shirt approaches these patients and starts getting their vital signs. The kids obviously an EMT student. If it wasn't the cliche uniform he's wearing, it was a large Shiloh County CC EMT Program patch on his chest that gave him away.


I approach the nurse and inquire about what's going on. She fills me in.


'Where are you going to put them?' I ask.


'East is full, and so is North.' she replies as she looks at the computer, 'looks like South is the only thing open. 11 & 12'. 


'Perfect' I reply. Those are my rooms I think to myself as I start to walk back.


The EMT student gets all the vitals, and hands them to the nurse.


'Take them both up to South. Ms Hawke is going to 11' she points out Hawke to the EMT student, ' ...and Ms Breslin is going to 12.'


The two are escorted back into their appropriate rooms. After I give the nurse a few seconds to get started on getting her new patient situated,  I walk in to 11, figuring this should be the fastest one to see.


I knock on the doorway before pulling the curtain back and entering the room.

'Ms Hawke', I say as I enter the room.


I enter the room.


'Good evening, I'm Dr. Chris Grant.' I say as I close the curtain behind me. I stand back a little bit to give the nurse room to work.


Hawke is sitting on the side of the stretcher. Perhaps a little annoyed that she has to be here, but I can't tell for sure. The patient's nurse is having her take her uniform shirt and vest off, stripping her down to her undershirt.


'So what brings you in to see us today?' I ask.


I hear about the officer involved shooting.


'Oh no.' I say in amazement. 'Any pain or injuries?' I ask


I take a quick one-over look and see that she has no obvious injuries or bleeding. I pull out my stethoscope from my coat pocket.


'I'm just going to listen to your heart and lungs, is that okay?' I ask. I move in to listen and ask:


'So how are you feeling right now?'

#58361 Emergency Department

Posted by Dr. Grant on 15 March 2019 - 02:25 AM in Shiloh County Hospital

'Okay then. I wish you the best, and if you need anything feel free to ask me if you see me or your nurse and we'll be glad to help you out where we can.' I say with a smile as I retreat out of the room. I nab a little hand sanitizer as I leave the room and rub my hands down. 


I make a couple notes on my note pad and proceed back to the nurses' station and log into the computer. I peek at the next patient's triage information.


'Breslin' I say to myself. 


I log out of the computer and make my way to room 12. I see Hawke's nurse: 'Hey Angie, when you get a moment can you double check to make sure we have everything we need for the patient in 11 before we get her discharged. There should be something in our papers from the Sheriff's department about what we need for officer involved shootings.' 


'Yea, I just got to push these meds in 10, and I'll look into it.' She says as she continues on her way. 'Thank you.' I say as I continue towards room 12.


I knock on the door frame out of habit as I go to enter the room.


'Ms Breslin?' I say as I enter the room.


'I'm Dr. Chris Grant...'


I pause. Breslin is sitting at the edge of the bed. She looks at me. Her face is really familiar. I see the EMS uniform shirt laying at the foot of the bed. I know her, she's one of the medic supervisors! We've worked together before. I don't know how I didn't recognize her from the start. I try and keep my composure and to treat her just like any other patient.


'So what brings you in today?'

#58359 Emergency Department

Posted by Dr. Grant on 15 March 2019 - 01:56 AM in Shiloh County Hospital

I take a look at the vitals.


Everything is good. She's fine physically. Emotionally...oh boy...she seems strong but I'm sure taking a life can have its toll even on the strongest.


There is a chair in the corner of the room. I pull it over next to the bed side and sit on the edge of it, putting me just below her eye level.


'Any medical problems?' I ask. 'Allergies?' Her history seems unremarkable until I ask the magic question:


'Any hospitalizations or surgeries?' She starts to tell me about heat stroke incident in 2017, and how she was shot before, and even a close encounter with sexual assault. Damn, she's been through a lot. She's one tough person.


I make it through her history and find nothing else really of concern.


I make eye contact.


'Physically, you're fine, and I think you knew that already when you came in right now.' I pause. 'What I'm concerned with is how you're going to be after all this has sort of processed and you've had some time to think about it.' I say sincerely. 


'This is not an easy situation. I'm not familiar with the details of the case, and frankly that's not my concern, but I'm sure you did what you had to do.' I pause and take a breath.


'Within the next few hours or even days, I want you to know that it's perfectly reasonable and normal to feel....doubt....guilt...or even a bit of anger about the whole situation. Being involved in a shooting is a really stressful event and different people handle it in different ways. Some are able to shrug it off pretty quickly, and for others it takes more time.'


I pause, look down at the floor, then make eye contact again.


'With that said, I'm sure your department will have you meet with a therapist within the next day or two, either a psychiatrist of psychologist, whatever they have arranged. I highly encourage you to meet with them at least this first time, even if you feel like you're doing well. I also encourage you to participate in any group debriefs that are held with the other responders that were involved. This will not only give you the support you need, but also allow you to help some of the others involved. So please be cognizant of yourself, and do not be afraid to seek help.'


I pause for a second to let that sort of sink in hoping that it's sticking.


'Okay?' I say to break the mood a little. 'I'm not exactly sure what policies your department has as far as any special testing that has to be done. Once I confirm that we have everything we need, I'll let you go on your way.'


'Any questions for me? Or is there anything else I can help you with?'

#58441 Emergency Department

Posted by Dr. Grant on 16 March 2019 - 05:45 AM in Shiloh County Hospital

'Wow. That's terrifying, and I'm glad you're okay.' I say to her. I can see the frustration in her face.


'Yeah, I know you're used to dropping people off here, not the other way around...let's see what we're dealing with here and hopefully I can get you out of here pretty quick.' I say reassuringly.


I start to move in closer and gesture to her side


'May I?' I ask as I move in to do an exam of her side.


'Which side is it?' I ask.


I get her permission to examine her side and start lifting up the side of her shirt to look at her injured side.


The skin overlying the middle of her side is red with some scrapes. I don't notice any gross abnormalities or bleeding.


'Any trouble breathing?'


I begin touching her side from top to bottom, first with the palm of my hand. I start with the upper portion, then the middle, then lower.


I apply light pressure.


'Breath in for me' I ask, making sure that everything expands normally and hopefully with minimal pain.


Chest expansion is normal and symmetrical.


I then reach behind and start feeling the side of the spine where the ribs attach to the vertebrae. Back muscles seem a little tense, particularly in the mid thoracic area. One rib, about mid back, appears to be more prominent than the others. I don't think much of it. It's not anything that's serious but something I might want to treat at the end.


'Any health problems? Allergies? Medications?' I ask as I inspect the opposite side for comparison.

#58455 Emergency Department

Posted by Dr. Grant on 16 March 2019 - 06:15 AM in Shiloh County Hospital

Uninjured side looks the same as the injured side, minus the redness and scratches. Looks good so far. I lower her shirt back down.


'Where else are you scratched up?' I ask.


She shows me a couple areas. Nothing but superficial scratches. Didn't even draw blood. 


'Alright, let me just have a listen.' I say as I pull out my stethoscope.


'Take some breaths' I say as I listen to her lungs. Clear.


'Now just breath normally for me' I say as I listen for heart sounds. Normal.


I quickly put my stethoscope in my large coat side-pocket and reach for her wrists. I feel both pulses.


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


Pulses are strong and regular.


'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?'

#58465 Emergency Department

Posted by Dr. Grant on 16 March 2019 - 06:46 AM in Shiloh County Hospital

'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?'

#58995 Dr. Braun's Office

Posted by Dr. Grant on 22 April 2019 - 04:29 AM in Offices



Dr. Braun, Dr. Abboud, and myself have just finished a lengthy QA/QI review of runs from the last month. With our work essentially complete we make small talk and get onto the subject of the nice weather recently. 


'Yeah. I just got a new smoker and I can't wait to break it in. With the weather being so darn nice I'm hoping to do so this weekend. Only problem is I end up making a feast out of it.' I say with a smile on my face.


A thought comes to mind.


'You both should come down and help me break it in....make an afternoon out of it.' I offer. I haven't cleared this with the wife yet, but I know she's never one to turn down a gathering.


'I'd have to clear it with the wife first, but I don't see her objecting. You're more than welcome to bring your spouses, kids, Gardners, whoever...'

#58013 Emergency Room

Posted by Dr. Grant on 24 October 2018 - 09:12 PM in Crescent Falls University Medical Center



Crescent Falls University Medical Center (CFUMC) is a medium-sized medical center capable of definitively dealing with most all medical patients and some trauma patients. Built in the early 1960s, CFUMC has undergone many extensive renovations over the years to keep up with modern trends in healthcare.


The emergency room is certified in the following areas of emergency care:

  • Level 3 Trauma Center - CFUMC is capable of dealing with most trauma patients, however, it lacks the 24/7 staffing of specialist surgeons necessary to earn it a higher trauma rating. Patients requiring specialized care are either diverted to Shiloh County Hospital prior to arrival, or are treated, stabilized, and transferred out once stable.
  • STEMI/Chest Pain Center - CFUMC is staffed with a cardiac catheterization lab and is fully capable of definitively dealing with patients who have a confirmed ST-Elevation Myocardial Infarction (Heart Attack).
  • Stroke Center - A full stroke team is on call and in house 24 hours a day to intervene and manage all confirmed or suspected stroke patients.
  • Perinatal/NICU Center - This hospital is capable of treating and caring for most acutely ill children less than 30 days old.




Isolation 1 & 2 - Negative pressure rooms, used primarily to isolate patients with potential infectious disease. When isolation is not needed, these rooms are used for regular ER patients.

Exam 1, 2, 3, 4, & 5 - Enclosed rooms holding multiple beds, separated by curtains. Modern hospital designs favor single occupancy rooms in the ER, however, this ER was built in the early 1980s. Despite recent upgrades, such as the addition of negative pressure isolation rooms, the ER retains its original 1980-1990s era design.

Curtain Area - Areas of beds out in the open, with privacy only provided through the use of retractable curtains.

Fast Track - A more modern concept, the Fast Track room, formerly a suture room, is used for patients with very minor complaints that can be assessed and treated rapidly, without tying up a regular ER bed.

EMS Room - Some say that this room used to be a janitor's closet, and the size sure confirms that. The room contains a refrigerator with juices and generic brand sodas (mini-sized) as well as small selection of pre-packaged sandwiches (typically left overs from the cafeteria). The door code to enter is well-known by local EMTs & Paramedics as 911#. Due to the room's incredibly small size, only one person can enter at a time. Two is possible, but the fit is rather tight.


The hospital was renovated in recent years, making it decently pretty on both the inside and outside.

#58012 Emergency Room

Posted by Dr. Grant on 24 October 2018 - 09:03 PM in St. Agatha's Hospital

St. Agatha's is located in the armpit of Delmore. It's an old hospital that seemingly is falling apart on the outside. The inside, however, is surprisingly clean but it still looks its age. It is a basic emergency department with no real special services except for psychiatric emergencies. All those with a Heart Attack, Stroke, or Trauma are typically stabilized and immediately transferred to either Crescent Falls University Hospital or Shiloh County Hospital.




It's small size means it's typically always busy and wait times can be long.

#58053 Emergency Medical Care Update 2018

Posted by Dr. Grant on 29 October 2018 - 05:32 AM in Announcements

EMS in Shiloh County is being tweaked a bit. Perhaps the biggest change is restructuring of the different levels of certification for EMS.


Shiloh County now recognizes a 3 level EMS certification system consisting of:

  1. EMR (Emergency Medical Responder) - Basic 80 hour course in advanced first aid. Scope of practice is comparable to EMT, however, without the ability to administer medications (except oxygen and oral glucose). EMR's also cannot staff an ambulance.
  2. EMT (Emergency Medical Technician) - The minimum level required to staff an ambulance and therefore work for SCFD EMS. Education is a 120 hour class + 36 hours of ride alongs.
  3. Paramedic - The highest level of pre-hospital provider. Education consists of a 5 month didactic course, 1 month of hospital clinicals, and a 3 month of field internship.

Due to budget cuts and low resource utilization, the fire suppression side of SCFD will no longer offer ALS level services. Policy will be updated to require that all new probationary firefighters will be certified to the EMR level as a part of their time at the fire academy. Current firefighters without any medical certification prior to this policy, will be grandfathered in and will not be required to become certified, however certification will be offered free of charge to them. Firefighters wishing to obtain their EMT certification will have the opportunity to do so as well. A stipend for being EMT certified will be given. Firefighters currently certified as paramedics will be allowed to keep their certification, but will be classified as EMT and be limited to the EMT scope of practice while working in fire suppression. After working with the local firefighter union, the county has come to an agreement to allow currently certified firefighter/paramedics to keep any stipends they receive so long as their paramedic certification is maintained. 


After some serious talk with the brass, as a consolation to those firefighters already certified as paramedics, a new policy will be drafted which will allow paramedic certified firefighters the ability to work overtime shifts within SCFD EMS, after completing an EMS orientation and field training program.


To better reflect these changes, fire apparatus will need to be updated to reflect their new BLS level of care. Lifepak15's currently in use on those vehicles will need to be swapped with Lifepak 1000 AEDs.


Sheriff's department currently only requires basic first aid and CPR for hire, and that is not changing, however EMR training is encouraged for interested persons.


Our three main hospitals have been updated, and 2 new forums have been added to reflect the other two hospitals. Each hospital has specific criteria and capabilities so please be sure you're sending your sick and injured to the proper facility.


Additionally, we hope to put out some training material to help those of you who are inexperienced with EMS. We will also be taking a look at existing policies and updating them accordingly. We will let you know of changes.


Our Medical Director list has been adjusted slightly:

Dr. Braun is still Medical Director of all of SCFD

Dr. Grant  is Associate Medical Director and will be overseeing SCFD EMS's ALS program

Dr. Abboud is joining us as an Associate Medical Director and she will be overseeing SCFD's BLS Program (to include for EMS and Fire suppression)

Both associates directors will be working to improve quality in both ALS and BLS, but each has their respective primary focus.


Finally, both EMTs and Paramedics in SCFD EMS will have access to online medical control during their call. Should a situation come up that you are not sure how to handle, or are completely lost, or if you need to make a pronouncement of death in the field, then please call Medical Control either by phone (preferred) or radio. Medical control will be able to guide and give you orders on how to proceed. There are currently two medical control numbers, one for Shiloh County Hospital and one for Crescent Falls University Medical Center. The primary number for SCFD EMS is Shiloh County Hospital, however, Crescent Falls University Medical Center can be called if you cannot get a hold of Shiloh County Hospital.



I appreciate your feedback on these changes. 

#58121 Dump Truck Vs Bus

Posted by Dr. Grant on 06 November 2018 - 04:38 PM in Emergency Call Out

*I'm walking down the hallway of Shiloh County Hospital towards the staff break room. Time for a quick snack and a breather. It's been a busy night. Just as I reach the door, my pager goes off.*


'That's weird.', I think. Usually, I get calls and messages on my hospital VOIP phone. It dawns on me....that's the EMS pager.


*I hastily grab it from my waste band, and take a look*


'MCI Activation-MD Required: Bus. Pls call FD EMS dispatch'


'Shit' I mutter to myself. In over a year, I have never had an actual MCI activation, in fact, this pager's only gone off twice, both were from the EMS shift commander asking questions about a crew screw-up.


I walk into the staff room and head over to the locker room area. I get on the phone and call EMS dispatch to get the information. I place them on speaker mode as I quickly change from my scrub pants into the pair of EMT style pants that I have in the locker for just such an event. I change my tennis shoes to boots, grab the pull-over job shirt I have hanging up. I finish getting the details and hang up my phone. I leave the locker room, break area, and hastily move to the ambulance triage area. Hidden in a cabinet in the EMS radio/med control room are two jump bags. I grab both of them and head out into the ambulance triage area towards the back door into the ambulance bay. 


'I got an MCI activation. Dump truck vs Bus, 15+ confirmed casualties. Monitor MedNet and the radios.' I tell the ambulance triage nurse and the nurse monitoring the EMS radio as I leave. They look at me puzzled, then spring into action notifying everyone they can about the pending influx of patients.


MedNet is a cool computerized tool that all of the area hospitals utilize. It allows hospitals to publish how many beds are available and whether or not they are open to receiving patients. Its very useful in situations like this, where coordinating with other hospitals to spread the burden of an MCI like this around the area is important. 


I head out into the ambulance bay where my response car is parked in the back corner. I unlock the door, pop the trunk and throw my bags into the back. The bags are mostly extra supplies, field surgical supplies, and MCI related equipment.


I head to the driver's side and get in. Before I take off, I shoot a text to Dr. Braun:


Got an MCI activation. enroute to dump truck vs bus. 15+ pts


After sending the text, I type the address into google maps. I start the engine, and pull out of the ambulance bay, pausing before pulling out into traffic. I pick up the car radio, turn it on and move it to the EMS dispatch channel.


"MD-2 enroute to North Third" I say. "MD-2 copy" I hear in response.


*I switch the radio over to Ops 1 to get a preview of whats to come, then I pull into traffic with lights and siren going. God it's been a long time since I've done this."

#58768 Cafeteria

Posted by Dr. Grant on 23 March 2019 - 08:27 AM in Shiloh County Hospital

The main cafeteria of Shiloh County Hospital features a wide assortment of food and beverages. It is conveniently located on the ground floor of the main hospital building and is easily accessible from both the emergency department and inpatient areas.


Breakfast: 6a - 9a

Lunch: 11a - 2p

Dinner 5p - 8p


Express Pre-Packaged Meals, Snacks, and Beverages available 24/7.


Items are priced a la carte at very reasonable pricing. EMS gets 10% off. Physicians employed by the hospital get a limited amount of credit towards food/beverage purchases each shift they work. The amount of credit depends on the length of the shift. It is generally enough to cover a modest meal for each 8 hours worked.


Features outdoor seating, which is open seasonally.