Saturday, September 13, 2008

Sick People Revisited

I started this post two days ago - finally I have a chance to publish it. The past couple of days have been a little busy, plus my Internet access has been limited because I haven't been home to get on my own little network.

We had a few rather ill people that we took care of on Thursday. It was one of those days where while we didn't do a lot of calls, the quality of them was pretty impressive.

One of them was for a 16 year-old male who was being sent to one of the local rehabilitation hospitals from Children's. He had scoliosis as well as some rather intense pulmonary problems, and he'd been at Children's for surgery to work on shoring up his spinal column. The rehab is for building up back strength as well as general conditioning. He's already wheelchair bound plus he had a tracheostomy placed a month or so ago. But overall he's actually doing rather well, all things considered.

He actually reminded me of my son - his mental demeanor (my impression was that he's quite intelligent) as well as his sense of humor. And he tolerated the ride better than I expected he would. He did need suctioning during the trip, and we had a nurse with us that handled that for him.

I was happy that he left the hospital to go on to bigger and better things.

We had another 16 year old - a female - who was going from Children's to the Franciscan in Brighton. She is from Kuwait, and her mother was with her. Neither speaks English that well. Actually, I should rephrase that: mother didn't speak any English. But that wasn't a big deal; in her mind there were these two large strange men who were taking care of her daughter. But she warmed up to us once we got underway. I think she appreciated what we did for them, although I can't help thinking that she probably thought it was strange that we were taking her Muslim daughter to a Catholic hospital.

This young lady was dealing with Chiari syndrome - something I don't know much about, so I can't really talk about it intelligently. But I will research it and discuss it in another post. All I know is that she needs surgery for it.

On our way back from that call we got sent to Everett to the local hospital there for a patient with a fracture to his first cervical vertebrae being transferred to the Massachusetts General Hospital. When we got the word of what we were going to I started thinking the worst -when we were told he wasn't boarded I was thinking we'd have to do that. After all, who in their right mind wouldn't immobilize a patient with a potentially life-threatening injury? But when we arrived at the hospital, we discovered that our patient, a 51 year-old male, couldn't be immobilized as he had a tracheostomy in place which he wasn't actively using but he would start coughing and become syncopal. In addition, he was ambulatory when we arrived. He had Titanium rods placed in his cervical spine from a previous neck injury, plus he has a history of throat cancer.

He was stable with no complications, however. No problems transporting him.

The best one was the 56 year-old male, status post liver transplant two weeks ago, back in for an ERCP. He had been seriously medicated - the PACU staff had given him large doses of Narcan to help clear him, but he had no changes to his mental status. In fact, he was really off the wall; the conversation he was having with himself was quite disjointed. It was pretty entertaining in a perverse sort of way.

Clinically, he had a lot going on. He'd had a chest tube placed, an arterial line to monitor his blood pressure continuously, fluids running, and a Foley catheter to monitor urine output. Plus he was restrained because he was trying to pull his Foley out as well as his central line. It was really challenging keeping him in check so that he didn't hurt himself. But we got him from Point A to Point B with almost no incident. I was happy about that, too.

I am now going to attempt bed. But anything can happen over the next 8 hours or so. Hopefully, nothing happens.

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