Yesterday a local dentist pulled an upper wisdom tooth and somehow managed to get into major arterial bleeding and brought the guy to the ER. We could temporarily control it with direct pressure, but any time the guy opened his mouth it was a major gusher. And, the guy was a "gagger" with a big tongue and limited mouth opening.Max/Fax was planning on taking him to surgery to ligate his greater palatine artery - but they were tied up for many hours in a big radical neck. So, what the hell, why not inject a little epinephrine into the palatine foramen like we "try" to do in palatine nerve blocks. So, with horrible visibility between the anatomy and blood all over the place, I used a needle like a harpoon in the general direction of the back end of the hard palate and squirted in a bunch of marcaine with epinephrine. (Not sure, might have missed and squirted it into the carotid or brainstem or something, for all I could tell.) Much to my surprise it either worked, or was performed just at about the time that the bleeding stopped spontaneously.
And to round out the day a posterior shoulder dislocation (the only one I can remember seeing that wasn't due to a seizure), a grapefruit size fungating cancer on a guy's hand (his GP had been trying various ointments on it for a ear), etc. I've cardioverted more folks in the last 3 months than I have in the last 5 years at University, and probably about 2 years worth at Boulder. And more profound bradycardias than I've ever seen.
Couple days a ago had a distal radius reduction in fastrack, so ketofol - no monitoring, no suction, etc, etc. Thankfully that went well and had been done by the Registrar before I heard about it.
I've got to remember to stop reading your blog while eating breakfast.
ReplyDeleteSounds like you're having an interesting trip. I think you're coming home soon, right?