more crowding & chaos

Another of those days with the ER jammed to the gills. One field STEMI (heart attack) notification that I wasn't taking care of, but the cardiology registrar arrived shortly after the patient and couldn't find the patient!!! I helped him look and we eventually found him sitting in a chair down the back hallway - fortunately with his pain resolved. At least he could lay down in the cath lab when he got there (I'm not actually sure, but I hope that he didn't have to walk over).

Had a guy still "ramped" - on the ambulance stretcher, waiting in line, not yet physically into or registered into the ER - but hauled the shitty little old, beat up ultrasound out to where he was and identified the hemo/pneumothorax (from having a big tree fall on him when he cut it down).

Dragged someone else out of the "theatre" (such a cool name for the little room where they don't do anything that anyone would actually like to view for entertainment - actually did have one "viewing" Dad of a patient hit the floor yesterday) so that we could get his chest tube in. XRay appeared to be at lunch or on break, so we never did see them - but CT showed up quickly and we got our "pan scan" done very efficiently (after the 1st 700 ml of blood was already in the Pleurovac). Trauma surgery showed up sometime or other and decided that we were under control and left some admitting orders and went off elsewhere.

The place is at times so understaffed that it is astounding that more people don't get hurt, but we run from place to place doing what we can and it all feels a bit third-worldish and mostly stuff gets done.

There are a few of our specialty Registrars (and consultants) who are distinctly unhelpful - perhaps assholes would be an appropriately descriptive term - but they stand out amongst a bunch who plunge in to the chaos and try to help keep the ass-deep alligators at bay.

It falls down with stuff like the previously healthy older guy who had had 5 syncopal episodes before arriving, including several that were long enough without pulses to get CPR. He had a normal ECG that would abruptly slow (sinus still) into the 40-30-20 and full stop for 20-30 or more seconds. There are no pacer wires available in the ER, so we ran him on boluses of atropine and an isoproteronol infusion (I don't recall using that since the 1970's) and external pacer. Cardiology wasn't interested in helping since it was later than afternoon tea. WTF! I hope the guy (cards) breaks an arm sometime so that I can flop it around a few times. And then let him wait for 6-8 hours to give him 10 mics of fentanyl. Medicine was stuck managing the guy overnight.

More later.