Monday, October 30, 2006

Life Lessons

There's an entire category of medical blogging known as the "things I learned from my patients" genre. You can find the great-grand-daddy of this literary form here, on a bulletin board that lists pages and pages of bizarre, self-destructive patient behavior, much of it involving drugs. These entries are very funny, but most of them are also decidedly unkind to the patients.

More recently, DisappearingJohn has been running a
Notes to Self series, which is a kinder, gentler version of this idea.

I have examples of my own -- so does anyone who's spent any time in an ED -- but I've been very cautious about posting them, because I don't want to sound as if I'm making fun of patients. I've decided to share two (from a much longer list) only because these were cases where the people involved genuinely thought they were doing the right thing; they were trying to be good citizens. So please understand that I mean no disrespect.

Animal Kingdom

Yes, we've read the books saying that if you're bitten by a snake, you should try to bring it to the hospital with you for identification, to be sure you'll be given the right antivenin. However, if you show up in the ED waiting room with a live rattlesnake, the staff will become extremely upset. (It's not easy to rattle ED staff, but a live rattlesnake will do it.) If you must bring the snake to the hospital, it should be dead. If it isn't dead when you arrive, it will be soon thereafter. If you like animals -- hey, many of us do, too -- and hate the idea of the snake being hurt (because after all, it was only defending itself), then please leave it in its natural habitat. We'll figure out some other way to identify the snake. We'll show you pictures or something.

Why God Invented Ambulances

If your buddy falls off the back of a moving vehicle at 70 mph, please, in the name of everything you hold holy, call 911. There's a time and a place for rugged self-reliance. This isn't it. Your buddy needs, at the very least, to be on a backboard and in a c-spine collar, those torturous devices that keep people's heads and necks immobilized. If you load him into the back of your car and drive him to the nearest hospital, you could cause him further injury. This is especially true if the nearest hospital doesn't happen to be a trauma center. If you bring your buddy here, the staff of this hospital will do their very best to help your friend, but they will also be making frantic phone calls to the ambulance company, requesting a Code-3 lights-and-sirens transport to the trauma center now.

Note: I've recently begun to realize that ambulances, although expensive, are probably the transportation of choice in many situations. I've driven myself to the doctor under conditions that made medical staff blanch and say, "You drove here?" In my case, we're talking only about pain so severe that I was weeping as I drove; granted, that's still not a smart idea, but these were situations where I was pretty sure that my condition wasn't going to get any worse (and, luckily, I was right).

A friend of mine recently had a small heart attack. He woke up with the classic elephant-standing-on-my-chest feeling and alerted his wife, who gave him an aspirin, piled him into the car, and headed for the nearest ED. He was talking to the ED doc within twenty-five minutes. "If we'd called an ambulance," he told me, "it would have taken longer."

"Maybe," I said, "but if anything had happened on the way, you'd have gotten medical attention. What would your wife have done if you'd had a bigger heart attack while she was driving?"

I've now decided that if I think anyone in my immediate vicinity is having a heart attack or a stroke, I'll call 911 rather than attempting transport myself. I'm sure there are other situations where ambulances are the way to go, and I welcome comments on the subject.

Update: I just found these guidelines from the American College of Emergency Physicians about when to call an ambulance.

1 comment:

  1. The other thing about calling an ambulance is that the hospital COMES TO YOU! And those medics will start giving you life saving drugs and treatment when they arrive at your house and while they're driving you to the hospital.


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