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.
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