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#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."

#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. 

#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 (CFU) is a medium-large medical center capable of definitively dealing with most all medical patients.


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

  • STEMI/Chest Pain Center - CFU 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.
  • Pediatric Medical Center - This hospital is equipped with a fully staffed Pediatric emergency department and is capable of dealing with most acutely ill children. Any child in severe/life threatening condition may be seen here.
  • Perinatal/NICU Center - This hospital is capable of treating and caring for most acutely ill children less than 30 days old.



[Interior Layout In Progress]


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.

#57781 Dr. Braun's Office

Posted by Dr. Grant on 16 June 2018 - 04:44 PM in Offices

I walk to the office door and look at my watch.




The door is closed. He's probably not here yet. I knock and try the door. It's locked. I hear someone walking down the hallway and turn around. Dr. Braun is walking up.


As he approaches I greet him, juggling my coffee with one hand.


'Good morning.' I say to him. He greets me back.


'So how was your trip to Florida?' I ask.


Dr. Braun's been on vacation for a week in Sunny Florida. I've had to attend the county EMS board meeting and meetings with the Fire Department brass on his behalf for the past 2 weeks. I'm meeting him today to talk about all the pending changes coming down the pipe.

#57780 Emergency Department

Posted by Dr. Grant on 16 June 2018 - 04:37 PM in Shiloh County Hospital

Sjostrom leaves without answering.


'Okay then.' I say to myself, not thinking too much into it.  I ask the patient instead and essentially get the same information. 


'Ok so you did get knocked out?' I ask the patient.


'I think so, Maybe for a minute.' he replies.


*I check his neck and head. Nothing seems out of the ordinary except for some dried blood, probably from his arm wound. He denies any pain and seems alert and oriented.*


'Ok so I want to do a quick CT scan of your head since you did get knocked unconscious. A blow hard enough to do that is more than capable of causing a bleed in your brain. I think it's unlikely but I'd really rather be safe than sorry with that. Other than that we're going to get that tourniquet off and see what kind of bleeding we're dealing with here. Once we get that under control hopefully it will be a matter of cleaning it out and stitching it up.'


*The patient agrees. I pull out a pen light to get an even closer look at the wound. I poke a prod it for a second. I see exposed muscle. This is going to require multiple layers of stitching.*


*I ask the man to move his hands and fingers. He does so. I check his feeling around the wound and below. Everything seems intact.

As a nurse finishes his vital I take a quick glance at them. Everything seems normal. I walk out of the room and over to a computer to start writing up the orders.*

#57774 Emergency Department

Posted by Dr. Grant on 06 June 2018 - 10:41 PM in Shiloh County Hospital

*I put some gloves on and make a line straight for his arm to take a look.*


'Hi, I'm Dr. Grant, I'm just going to take a quick look at your arm.' I say as I inspect it. I see a single wound, fairly large, but decently clean cut. Should be easy enough to suture. 


'What kind of knife was it? Any other injuries? Loss of consciousness?' I ask.

#57771 Emergency Department

Posted by Dr. Grant on 06 June 2018 - 09:55 PM in Shiloh County Hospital

*I sit at the nurses station, working on my charts. I'm aware that there are two stabbing patients coming in. The trauma team is in the trauma bay working on the first patient who just got brought in. I got delegated to manage the second patient.*


*As the EMTs enter the ER I overhear the nurse in ambulance reception asking if this was the arm stabbing and I hear one of the EMTs answer affirmatively.*


'This is mine.' I say softly to myself as I logout of the computer and stand up. 


'Trauma 10' I hear the ambulance reception nurse tell the crew. I watch them wheel the patient over to the room and help him up into the room. He doesn't seem too bad. I walk over to the EMTs.


'So what do you have for me?' I ask Sjostrom.

#57666 Dr. Braun's Cell phone

Posted by Dr. Grant on 24 May 2018 - 05:56 AM in Social Talk

Text Message:


Good evening Dr. Braun. Are we still on for our meeting at 10am tomorrow to discuss the new FD EMS updates? Meeting in your office correct?

#57652 Emergent Transfer (Uncontrolled Bleeding)

Posted by Dr. Grant on 22 May 2018 - 10:17 PM in Emergency Call Out

I feel a large deceleration, faster, and faster, until I hear Sparks shout ‘Hard Stop!’.


‘Uh oh’, I think to myself. I lurch forward with the jolt of the massive deceleration. My hand slips from its position, unleashing more blood.


After the jolt, Breslin and I rush to stop the bleeding again. We struggle but manage to get back into our previous position. The bleeding stops.


‘Maggie. Give me a thumbs up.’ I say. She does so. She’s pale as ever, and I don’t know how much more of this she can take. We’re running out of time. The blood bags have pretty much ran out at this point, and to make matters worse, the hand occluding the bleed starts to cramp. I fight through the pain. If I let go, that might be the end of it.


It seemed like an eternity, but eventually I felt us speed up again. I looked out the back window and saw the massive pile-up of cars on the bridge. I was in disbelief.




Before I even realize it, we have arrived at County Hospital.

We start to back in. I can’t believe we made it.


‘Maggie, we made it. We’ll get you inside and get you all fixed up. Just hang in there with me a little longer.’ I say.


The back doors fly open, and Sparks unloads us all carefully, with our hands still in position. He pushes the stretcher up towards the double doors of the ER ambulance entrance. The doors open and a man in light green scrubs appears. Dr. McKnight, just the man who I wanted to see. We approach rapidly and pass through the doors. He starts walking along side me as we pass.


‘Dr. Grant’ he says to me, cool as a cucumber. ‘Dr. McKnight’ I say in return. ‘How’s she doing?’ he asks.


‘She’s holding in there. I think I have whatever is causing the bleed occluded with my fingers, but we’ve gone through several units of blood just to get her here.

Last BP, as we were pulling in, was 84/52 and a heart rate of 135. She’s still conscious and alert.’ I reply.

‘Kevin, I think it’s the axillary artery but I’m not sure.’


We pull into the trauma bay. At least 7 people are there, fully gowned up from head to toe. We carefully move her to the trauma bed from the stretcher. Sparks and a trauma tech disconnect all of the monitor leads and BP cuff from the patient. Sparks slides the stretch out and takes it outside. Breslin is still holding pressure on the patient’s upper chest area. Dr. McKnight finishes gowning up and get right next to me. He slides his hand up where mine is.


‘Okay, I’m just going to slowly move my fingers above yours.’ He tells me calmly.


He places his fingers just above mine.


‘Okay. Now slowly take your hand out.’ He tells me.

I pull my hand out as he advances his inward. My hand is now completely free and I take a step back.

No bleeding.

Dr. McKnight has control of the bleeding. He fumbles around a bit with his fingers and finally tells Breslin to relieve pressure. She does and steps back. At that moment the sea of gowned trauma team members stepped in and started doing their thing.


I walk outside of the trauma bay so as to be out of the way. I take a deep breath and smile. Holy shit. We did it. I take a couple more sighs of relief. I slowly look at my hands and arms. My glove was completely stained with blood, my bare arm covered in fresh and drying blood. My scrub top, pants, and shoe covers were covered in blood. I looked like a bloody mess. I headed over to the wash basin and took off my dirty gloves and began washing my arms and hands vigorously. Once I was satisfied with their cleanliness started to make my way to the staff locker area. As I turned away from the sink I see the trauma team rushing by. Dr. McKnight tells me in passing with his hand still inside the woman’s chest. “We’re taking her to the OR. She’s going to make it. Good work getting her here.” He says. As the team and the patient disappear around the corner, I myself soon disappear into the staff locker area. Lucky for me I keep spare scrubs at this hospital. I change into clean scrubs and put the dirty ones into a biohazard bag and throw them out. Nothing’s going to get the stains out of those. I walk outside into the cold air. It’s still dark. Sparks and Breslin are finishing cleaning the disastrous mess left in the back. I approach both of them and thank them for their help.


‘I really wouldn’t have been able to do it without you guys. Thanks.’ I say to them gratefully.

‘…and word has it that she’s going to be just fine.’ As I say that I can see a sense of pride and accomplishment come across their faces.


I look down at my watch….5:06am.

#57523 Emergent Transfer (Uncontrolled Bleeding)

Posted by Dr. Grant on 17 January 2018 - 07:40 PM in Emergency Call Out

We take the first hard turn.

As we start into the turn I can tell...this isn't good.


I lurch away from the patient, as does Breslin and my hand slips out of the patient's armpit, and Breslin is knocked slightly off of the seat at the head of the patient. She is forced to use both hands to prevent herself from falling completely over.


Immediately, blood starts spilling everywhere. It's all over the floor, the cabinet face, the stretcher, and it just continues to pour out.


'Shit' I say to myself under my breath.


I get myself back into position and I place my hand back inside the hole in her armpit.


'Get back on that chest' I say to Breslin.


We struggle for a few seconds, but manage to stop the bleeding again. 


'Give me a thumbs up Maggie' I say.


She give me a weak thumbs up, but a thumbs up none the less. I'll take it.


We make another turn. My hand slips out again. Once again, blood starts pouring out, even with Breslin holding pressure. She adjusts her hand position to try and stop the bleeding.


I reach back into her and try to push against the vessel. Blood is pooling on the ground. It swishes back and forth along the floor with every movement of the ambulance.


We finally manage to stop the bleeding again.


We start to slow down. 'Oh God I hope we haven't run into traffic' I think to myself.


'There's no traffic at this hour of the morning is there?' I ask Breslin.


My hand is starting to cramp and I can tell Breslin is getting pretty uncomfortable too from holding so much pressure.

#57516 Emergent Transfer (Uncontrolled Bleeding)

Posted by Dr. Grant on 15 January 2018 - 10:17 PM in Emergency Call Out

As we leave the ER room, I maneuver myself with the stretcher and clear the doorway of the patient's room. My hand inside her warm slippery chest, pushing hard to maintain pressure on whatever was bleeding.


As we start down the hall, my eyes glance down at her face. I am amazed at what I see.


She has regained some of her natural color. She was no longer grey colored, and better yet, her eyes moved and looked at me tiredly. 


"Maggie. Maggie. Can you hear me?" I ask loudly.


Her eyes fix on my eyes. I know she can hear me. She tries to say something but she can't. She tries to move her head, but again, she can't. The blood loss has made her weak, that even the simplest task is difficult.


'Maggie, can you give me a thumbs up?' I ask.


She struggles. Her arm trembles, and finally I see her make a weak fist, and her thumb rises up as she slowly turns her wrist upward. She gives me a thumbs up.


'Alright Maggie, we've found where you're bleeding from, but we're taking you to County Hospital where they can permenantly stop the bleeding. I want you to stay with me. You're going to be fine.'


I can't believe I said that. Much of the patient-physician relationship is founded in trust, and it is the physician's duty to always be straight forward and never make promises that you aren't sure you can keep. To be completely honest, I really wasn't sure if she would be alright. F&$k it. If I was her, I'd want that glimmer of hope, even if it wasn't for certain.


Sparks, Breslin, myself, and a tech make our way to the ambulance bay. As the automatic doors open, revealing the outside air, I am hit with a blast of frigid wind. My scrubs and light underwear do nothing to protect me from the stabbing cold of this evening. We move briskly towards the medic unit. Our breath visible in the air. I'm freezing, but I take little notice. There are more urgent matters to attend to. Sparks unlocks the ambulance and opens the back. With the help of the tech, we carefully load ourselves into the ambulance while Breslin and I maintain our positions. We load without incident. Sparks jumps into the back and starts hanging the IV bags to the roof of the ambulance. It only takes him a few seconds, and exits the back.


'Ready?' he asks.


'...as we'll ever be' I say in reply. 'Just get us there as fast as you can'.


He nods, and closes the back doors. Shortly thereafter the engine starts, and we start moving with a forward jerk. I near lose my balance and finally sit down.


'Give me a thumbs up Maggie' I say.


She does.

#57502 Emergent Transfer (Uncontrolled Bleeding)

Posted by Dr. Grant on 08 January 2018 - 09:37 PM in Emergency Call Out

Now is really not the time for shenanigans, but whatever. I'll let it slide.


After what seemed like a blink of an eye, the blood arrived.


'I need that hooked up and ready to go.' I say. The nurses get immediately on it, hooking up the new bags of blood.


'Let's get that stretcher in here and lets start getting her moved over so we can get out of here' I say loudly out towards the hallway.


As Sparks brings the stretcher in, a tech move everything around in the room to make enough space for the stretcher.


We need to get on the road like now.

#57489 Difficulty Breather

Posted by Dr. Grant on 06 January 2018 - 06:08 AM in Emergency Call Out

'I need 5 more units of O-Neg for her.' I tell the nurse who hands me the phone. She immediately gets on another phone to the hospital blood bank.


I answer the phone.


'This is Chris Grant, who am I speaking with?'


I hope and pray that the voice on the other end of the line is someone I know and have worked with before. While I've been working there a couple months, I really only know a handful of the trauma surgeons all that well.


'Hey Chris, it's Kevin McKnight.'


Thank God...someone I know.


I'm about to sound really crazy explaining this case over the phone, and having someone on the other end who knows that I'm not some incompetent quack is really going to help things along. Kevin's a good guy. He helped me out and gave me some pointers about how to work well with the trauma service when I first started at Shiloh County. Ever since then we've hit it off. He's a bit of a prankster so we usually go back and forth. Last week he wrapped my coffee mug in casting material...so I still owe him a good one back...but that's for a different time. This is a serious situation.


'Hey Kevin, I'm over at St. Aggie's ER and I have a thirty two year old patient who's bleeding uncontrollably from her right axilla. It appears to be an old surgical site, probably from a ruptured A/V graft, but to be completely honest, I have no idea. Whatever it is, it's vascular and she's losing blood faster than we can pump it back into her..'


'Do you know what vessel is ruptured?'


I replied truthfully. The fact is while we as doctors are smart and know a lot about anatomy and physiology, we don't know every small detail, especially in the emergency department.


'I have no clue, but I've got small measure of control by putting pressure on her upper chest near what I think is the axillary artery but I'm not totally sure. Whatever it is...its bad. She's in terrible shape. General surgery here won't touch it with a 10 foot pole and we don't have an in house vascular surgeon tonight. If I don't get her down to you guys soon, she's not going to make it.'


'How long will it take you to get here?' He asks.


I look at Sparks:


'How long will it take us to get to County Hospital from here?'


He thinks for a second and tells me: 'Ummmm...12...15 minutes?'


'I can be there in 15 minutes. Get your team and a vascular surgeon ready for me. I'll see you soon.' I say over the phone to Dr. McKnight.


As I start to move the phone away from my ear I hear Dr. McKnight reply: 'Got it. I'll see you.'


I hang up the phone and start to walk back into the room. I look at Sparks.


'Get ready to get her loaded up, because we gotta move.' I say. 


I hear Breslin make her objection. I look at her and then continue back to the patient's side.


'No, this our problem. She doesn't have time to wait for another unit. It's a miracle that you guys are here already. Maybe now she has a chance. Besides, if MedStar had a long ETA we'd only be calling you guys back out here anyway.'


I don a new pair of gloves and stick my hand back into the hole in the patient's armpit. I think I feel the source of the bleeding.


'He can't sign.....No I told you he cannot sign....His hands are literally inside the woman's chest!' The nurse argues on the phone with the blood bank.


'Where's that O-Neg?' I ask out loud as I probe the hole with my fingers. 


The nurse looks frustrated and replied back to me:

'The blood bank won't release anymore blood until they get a physician's signature on some form.'


Oh for goodness sake. Hospital bureaucracy at its finest. 


'If you want his bloody finger print he can give it to you...other than that he can't sign the form.' She continues to argue.


Apparently her pleas were successful, because she soon thanked the person on the phone and gave me the good news:


'They're running the blood down now'


Perfect. As soon as the blood's here we can get the heck out of here. 


Since I'm unable to grasp what I think is the ruptured graft with my fingers, I try a different tactic. I simply try to push down on it as hard as I can, in hopes of blocking it.


'Let up a little bit' I tell Breslin. 


Blood starts to pour out again. I start move my finger around to find the right position. After some time I manage to stop the bleeding. The position is uncomfortable, but it seems to work.


'Keep holding pressure. I think I have it, but it's a hard position to hold.'


#57485 Difficulty Breather

Posted by Dr. Grant on 05 January 2018 - 02:33 AM in Emergency Call Out

From around the corner I hear the charge nurse say that she's paging Dr. Grant now.


Oh boy. Here is to goes. I make my way around the corner and see the flood of people run out to the ambulance bay.


'What's going on?' I say. The charge nurse looks at me. 'We've got a drop off in the bay. Possibly a GSW or stabbing.'


'Alright, which room are we going in?' I ask.


'2' she replies.


I walk into room 2 and start preparing for the worst.


'Get me O-Neg blood and saline. I also want an intubation try out and ready.'


Before I can blink, the patient is being brought into the room. I lay eyes on her for the first time. She is grey. Completely grey. I've seen dead bodies with more color than she has.


This woman is dead. I think to myself. She is soaked in blood. Head to toe, there is not a dry patch left on her. As the tech puts her in the middle of the room I ask the patient's mother what happened.


She says that she doesn't know, but she just started bleeding. She doesn't know from where. When I asked about her history all she said was the she has dialysis for kidney problems. I look her over. I check for a carotid pulse in her neck. I feel one, very faintly. She's alive! I then start a head to toe search to try and find something. Some source to the bleeding.


Nothing. No bullet holes, stab wounds, or any sign of active bleeding. The monitor gets hooked up and it show a very fast rhythm. 176 beats per minute. The blood pressure is struggling to get a reading. I have nurses starting IV's and running multiple bags of saline and O-Negative blood.


'What's her name?' I ask the mother. 


'Maggie' she replies. 


'Maggie? Can you hear me?' I say as I search her body and listen to her shallow, barely present breathing.


No response.


'BP 50/39' someone shouts out. 


'Can i get her on an oxygen mask please?' I say looking at a tech. He starts to fumble through the drawers for a mask.


Finally, as I'm look at her arms, I notice a small hole in her armpit, surrounded by sutures. This has got to be the source of the bleeding....but it's not bleeding anymore.


I start to investigate more, as the blood and saline pump into this 30 something year old woman. She's probably around my age. I ask the patient's mother about the incision and she tells me that he daughter had surgery two weeks ago in her armpit to place a dialysis shunt there.


Did her shunt burst? That would explain the massive bleeding. An artery and vein, literally open to spill there contents into the outside world. Just as I'm thinking about this, blood starts to pour out of the hole. Blood flowed everywhere, covering the floor in seconds. Great. She's bled so much that her blood vessels actually clamped down and stopped the bleeding, now my treatment of pumping blood and fluids into her has overridden that and caused her to bleed again.


'I need gauze here' I say. I'm handed a wad and start to pack the hole with gauze. The bleeding continues. I pack more and more gauze in, which last only a few seconds before they become completely soaked. I try for over a minute to stop the bleeding by packing the wound, but it does little to slow the bleeding. 


My God. She's going to die if I can't get this stopped.


I look over to a nurse: 'I think its a ruptured A/V shunt, I need you to get a general surgeon down here now.'


She runs off and grabs the nearest phone.


Think. Think. Think.


There has to be something you can do to stop this bleeding. A/V shunt in the axilla.....it has to be the axillary artery. I put my hand on her upper chest just below her clavicle and push down hard near the shoulder. My fingers go white with the amount of force I'm applying.


Nothing. Still bleeding. I move my fingers over a little bit and try again. 


The bleeding slows.


'There we go'


Just with this moment of success a nurse comes into the room. 'Dr. Grant I got ahold of the general surgeon...'


She paused. This can't be good.


'...but?' I say during the awkward pause.


'...but he refuses to take this patient. They don't do vascular cases. They're not vascular surgeons.'




'What about a vascular surgeon then?' I ask in desperation.


'There is no in house vascular surgeon right now. They have to be called in which can take up to an hour.' she tells me. 


I'm in complete disbelief. Here I am, this lady is bleeding to death and I have no one coming to help me.


'Contact Shiloh County Hospital and get ahold of trauma surgery.' I say. 


She turns around and gets back on the phone. I've slowed the bleeding but this is only a temporary fix. We continue to pump blood and fluids in her as fast as we can.


I need to see if I can clamp off the affected artery, but I'm a little tied up here. I need to find someone to take over holding pressure on the axillary artery. 


I pick out the first person I see who is not busy. 'You!' I point to Breslin, who's peaking her head through the doorway. I need you to come in here and hold pressure right here. I guide her into position and have her slide her hands over mine. As I slide mine out blood begins to gush out of the wound again. 


'Push harder....harder....harder...'. I say until the bleeding stops again. 'Good. Just hold it right there.' 


I move over to the patient's armpit and use scissors to cut the remaining sutures and make the hole in her armpit bigger. I can't see anything inside the hole. I'm able to place some fingers into the hole and start to feel around. I feel the graft and try to pinch it with my fingers. It's slippery and difficult to get a grip on. I try again.


'Doctor, I have shiloh county trauma surgery on the phone.' the nurse tells me.


'Great' I say. I pull my hand out and walk over to the phone.


I pass Sparks and grab the phone. I look at him: 'Don't go anywhere. I'm probably going to need you guys to run us over to another facility'.


I put the phone receiver up to my ear.

#57480 Difficulty Breather

Posted by Dr. Grant on 04 January 2018 - 11:35 PM in Emergency Call Out

It's cold as all hell out here....but at least its quiet. The night started out crazy, but between myself and the other physician we got the place under control. Heck, we even have an empty bed or two. I took this one, and possibly only, opportunity for some peace and poured myself a nice hot cup of coffee and took a stroll out in the ambulance bay.


The cold still air was a nice refreshing change from the emergency department. Working at Shiloh County Hospital has made me spoiled. Working the smaller basic emergency departments is a bit more challenging considering I don't have access to all the resources of a major hospital, but I don't mind it. It keeps me on my toes and forces me to be a little creative.


The silence of night gradually fades into the sound of a siren. The siren grows louder. Looks like it's headed our way. Good thing it's the other doc's turn for a new patient.


I see the ambulance back in and watch the crew unload. They're familiar faces I've seen a few times, but I'm terrible with names.


'Hey guys. Keeping warm?' I say.


'Barely' Sparks replies, 'What are you doing down here?'


'I work at smaller ERs once or twice a month for some extra money to pay off those student loans.'


'Right on' sparks replies as he passes and enters the ER.


'I think room 1 and 2 are open for you guys.' I say to them as they pass. 


'Thanks' they reply.

#57433 Emergency Department

Posted by Dr. Grant on 14 November 2017 - 07:18 AM in Shiloh County Hospital

"THE NURSE IS GOING TO KILL ME!!!! THE NURSE IS GOING TO KILL ME!!!" the shouting of a frightened man rings through the halls of the busy ER. Everyone is silent. A few nurses crowd the doorway of room 6.


"THEY'RE ALL GOING TO KILL ME! PLEASE KEEP THEM AWAY!!!" The shouting continues and the man's voice breaks down into crying "I'm just trying to get you some medication..." a nurse said trying to reason with the man who squated in a defensive posture on the ER gurney. "NO YOU WORK FOR THE MAFIA AND YOU'RE GOING TO FINISH ME OFF!! SOMEONE PLEASE HELP ME!!!" he shouted.


I walked over to the room. Mr. Houser, is a 43 year old homeless man with a severe history of paranoia and countless other mental disorders. While he often keeps to himself, he does seem to wind up visiting us when he's having one of his paranoid episodes. This one appears particularly bad.


"So he's convinced you're going to kill him?" I asked the nurse outside the door. "Yeah, I just tried to get a line started on him and he went ape-shit." 


I smile a little bit and proceed to walk into the room. Two nurses are present trying to calm him down. "PLEASE DON'T KILL ME! SOMEBODY HELP!!!" The man screamed as he cried in sheer terror. 


"Mr. Houser....what's going on in here?" I asked calmly.


"PLEASE HELP ME, I WITNESSED A MURDER IN 2015 AND THE MAFIA KNOWS AND NOW THEY'VE SENT HITMEN DISGUISED AS NURSES TO POISON ME." he shouted as the thick dirty beard on his faced rolled with each word.


"Ok, why doesn't everybody step outside of the room." I say calmly in an attempt to gain control of the situation. One of the nurses turns around and start to walk out and whispers to me: "Should I call security?"


"No, I think we're good here" I say in reply. "Mr. Houser, what makes you think they're hitmen?" I ask.


He stands completely upright on the gurney, towering over me, and I get a wiff of the unmistakable stench of homelessness. "THEY TRIED TO INJECT ME WITH POISON. THE GODFATHER WANTS ME DEAD. HE KNOWS I WITNESSED HIM MURDER AN ENTIRE FAMILY ON 34TH ST! NOW THEY'RE GOING TO INJECT ME WITH POISON."


The last nurse leaves the room. "It's okay, they're gone. Why don't you sit back down before you hurt yourself." 




I try again to get him to sit down. "Please, just sit back down and we can talk about all this."


Finally he sits back down.


"Please you got to help me, they're going to kill me. Call the state police, they're the only ones who believe me."


"I believe you. In fact, I'm going to help you out." I say reassuringly, "Let's just get you...." he interrupts me:



Recognizing that Dr. Kirolos is one of the staff psychiatrists I jump for joy on the inside. Thank God.


"Okay, I'll tell you what. I'll give Dr Kirolos a call and see if he can come down to have a chat about your situation. In the meantime I'll post a guard outside your room to make sure no one comes in to hurt you."




"I'm only able to help if you can stay calm. Can you do that for me?" I try to bargain with him.


"They're going to kill me dead, you've got to help me."


"I will, you just have to promise that you'll remain calm. Deal?" I cross my fingers.


"Please. Help me."


"Deal?" I try a second time.


"Fine, but please, help me...he wants me dead and they all work for him."


"Ok, no one will enter to room and I'll post a guard outside to make sure of that okay?"


"Please get me out of this death house" He begins to cry again.


"We'll get you taken care of, I promise" I say. He continues to sob and I walk out. 


Outside of the door I tell the nurse that I don't want anyone going into that room as it would only set him off again. I also instruct them to get security down here to wait outside the door incase he starts acting up again and we have to get him restrained.


I walk over to the nurses station and pick up the house phone and dial the operator. "Dr. Kirolos, psychiatry please." I say into the phone. It begins to ring.