Fog

Life in the rural medical world: guy with known CAD develops acute pulmonary edema, presents at 11 PM to a tiny hospital. They immediately decide to ship him - as they should, but fog has closed down the Launceston airport where the air ambulance is based - and it's a 5 hour drive to Lonnie, so they go for the 3 hour drive to Burnie - which is a bit better equipped than the really small place. There he's got a little troponin bump to .09 (no acute changes on ECG), and he gets nitroglycerin and Lasix. So, when the fog finally clears, EMS flights (the retrieval service) goes and gets him. By the time he gets to me - 12 hours after the 1st hospital arrival, he's no longer short of breath (never had chest pain), his chest x-ray has now cleared, his troponin has risen further to 2.24, he's already had his Plavix and enoxaparin at the second hospital, and in an hour he's off to the cath lab. Not bad considering all the travel time involved. The fog was gone and it was a beautiful sunny afternoon.

Even though we're about 3 hours from the East Coast beaches, we get stuff from out there - today was a body boarder that face planted into the sand off a large wave. Paralyzed and had to pulled out of the water by friends to keep from drowning. Largely recovered except for a little paresthesias and hand clumsiness by the time she arrived at ER. That was Saturday - they only did a plain film: normal. (Oooops.) Sunday, back to ER - CT:" normal (Ooops.) Back today - MRI showed minimal amount of cord signal, but no ligamentous injury: presumably a central cord syndrome. Treatment: nothing. OK - so the plain films, and even CT were not terribly sophisticated, but eventually all the tests we had led to the same spot: wait it out - you'll probably get back to normal or near normal.

A few other goodies: superior mesenteric venous thrombosis without clinical or imaging evidence of bowel necrosis - admitted for anticoagulation. More A Fib for cardioversion. And, lots of chaos - same as most days.