Island in the Sun

Wow, I’ve got the day off, it’s sunday. It’s almost felt like a whole weekend off, because yesterday, after call I didn’t go to sleep. Instead, I went to the first annual “Tour de Tykes” mountain bike race to raise money for our local children’s hosptial. One of my friend organized the entire event, and it was very impressive! There was also a kid’s race and a bike parade afterwards. The mid-point of each 8 lap race was back at the starting line. The race course was a figure 8 loop in the mountains behind the hospital. My friend built a bridge over the creek bed, and in the first half of the lap, you ride over the bridge. In the second half, you ride under the bridge. It was a great location for a ride and a wonderful way to spend the day in the sun!

The last half of my call on Friday night consisted of one new admission, an ATV rollover accident. Unhelmeted, of course (how could anyone be so dumb?). He had about 7 cracked ribs and his left chest was full of blood, so he was intubated at teh scene by the medics. A chest tube was placed in the trauma bay. A chest tube is insterted by making an incision between two ribs, sticking your finger in to feel the intercostal muscles (the meat you eat when you get a rack of bar-b-q ribs), and punching through the muscles to enter the lung space. Hopefully, you don’t pucture the lung and injure it worse when you do this. A large plastic tube with drainage holes is then placed through the hole in the chest, and attached to suction. This helps remove all the fluid, blood and air, and provides a negative pressure to help re-inflate the lung. A c hest tube usually stays in for a couple days to a week until it stops draining fluid and air.

Taking care of this patient was pretty straight forward from my standpoint. He needed a central line put in. an intravenous line placed into a large central vein, in this case, his subclavian that runs right underneath the clavicle. The catheter then continues into just above the heart so medicine can be admistered easily and get pumped immediately to the rest of the circulation. After having missed the last two lines I tried to put in, this one was refreshing. One stick and I was in the vein. The actual procedure probably took about 2 minutes, not including suturing the end of the catheter to teh skin. Sometimes they can take an hour depending on how hard the vein is to find.

Strangly, my favorite part of that admission was putting a splint on his hand. in the accident, he managed to break the 2nd metacarpal, the long bone that connects your index finger to your wrist. I went down the the emergency department to get some fiberglass splinting material and finally around 7:15 AM was able to put in on (after finishing prerounds on all my other patients). For some reason, I found it very relaxing and satisfying…partly because I knew that even though we had sedated him with pain and anxiety medicine, his hand would be a lot more comfortable immobilzed. The orthopedic surgeons will come up to see him later.

Well, the sunny day is getting away from me, I’m going to go play outside for awhile.

Remember, if you email me with the artist/author of the title of my post, I’ll mention you in my next post!

Be Famous!

1) You’ll notice that many of my post titles are song or book titles, or a line from a song. The first person who can email me (atkinson AT alumni DOT pitt DOT edu) with each post and tell me who the artist/author is will receive special mention in my next post!

Some titles thus far in my webog entries:

Infra Red X-ray eyes

I want a new drug

Hinds Feet on High Places (a book title, tell me the author)

Raise High the Roof Beams Carpenter (a book)

No Motivation (mabye only Penn State grads and Zeno’s patrons will get this on)

Good luck

An interesting first-hand account of Malaria at medical weblog

Feet First.

I must return to the unit now, it’s almost midnight, and I’ll be up till morning. My migraine isn’t quite gone, but it’s a little better. Hopefully the night is quiet.

Infrared X-ray eyes

I’m exhausted. The long nights with little sleep are catching up to me. Everyday I feel more and more like a doctor here. I feel more comfortable with crises and procedures here in the unit. Today I did my first procedure under fluoroscopic guidance. Fluoroscopy is like a continuous x-ray in real time. We had placed a central line that, instead of going into his heart, made a left turn at his neck and went up into his skull. Under the fluoroscopy machine, I set up a new central line kit, withdrew the catheter until I could see that it was no longer headed north, advanced a new guidewire and nudged, pushed and pulled until I saw teh wire flip around and head down towards his heart. Yahoo! It was so cool to see it happening w hile I was doing it. Most of the procedures that we do are done “blind” and you only find out after you order an x-ray if the tubes, lines and catheters are really where you wanted them to be. This one I knew for certain was in the correct spot, because I guided it in real time!

While I was finishing up the procedure, the cardiovascular surgeon came up to me and saw me dressed up in the lead suit with sterile gown & gloves on top, and the large videofluoroscopy equipment sitting in front of the room. It was right around 4 o’clock, when the evening staff comes on, and my upper level resident was down in the CT scanner with another patient, so I was doing the procedure by myself. All that fluoroscopy equipment looks pretty fancy and intimidating, so when the evening staff and the other attendings all stopped by to see what was going on in the room and saw me there handling everything by myself, I felt pretty good!

Well, might as well hit the tree.

Remember the man I mentioned about 2 weeks ago who had swerved to avoid a deer and ended up hitting a tree? A week later, he came to the hospital with encephalitis that we initially thought was related to an undiagnosed skull fracture. Later, the neurologists decided that it was coincidental, and that his encephalitis was more likely coincidental. Today he died. He coded on the floor…The neurologist, radiologist, IV team were overhead paged to a floor “emergency”. After hearing all three in succession, they finally overhead paged the Unit attending, who chuckeled at hearing his name…Imagine…if you were in the hospital and were in a condition that required Emergency X-rays, a neurologist STAT, and the IV team stat…wouldn’t you also want a critical care specialist there? Well, they brought him over to the unit in the midst of CPR. His condition continued to deteriorate as my colleagues ran through each branch of the ACLS (Advanced Cardiac Life Support) algorithm in turn. Last effort measures include needle decompression of the chest and pericardiocentesis…usually when the patient as been asystolic (without a heart beat) for some time and no other measures are working. Needles were passed into each lung field in the hope that a compressed lung might be decompressed, but it didn’t work. The code was called, (“Time of death, etc…”) and we continued on with our daily work without missing a stride.