Friday, August 10, 2007

The karma gods are angry

So I realize my last post was all about conciliation, but last night, all I could think about was my anger at the orthopedic surgery team. Orthopedics is a fascinating specialty, I'm sure, but the practice of it trains that tribe to regard anything that cannot be solved with a stainless steel power tool as beneath them. So when, for example, a patient who had a hip fracture repair is semi-stable but has a few co-morbidities that make them nervous, they are quite anxious to transfer her to a medicine team.

Unfortunately, they performed this transfer directly to my staff, without informing me, the guy who would actually get paged to her bedside about an hour later to find a patient I didn't know with new ST depressions of 5mm in all her precordial leads and a tachycardia to the 140s, complaining of chest pain but unable to point to it, because she also developed sudden onset of bilateral paralysis from the neck down. To add beauty to the situation, the patient also had mental status changes and was unable to tell me anything about her history, and the chart was full of worthless surgery notes saying "vital signs stable" and "wound healing without signs of infection" but little else. The nurses were able to tell me that the patient at baseline had left sided paralysis, but that the right was new. And fortunately the orthopedic team had ordered a nephrology consult at some point, so the life-saving nephrology consult note functioned as my understanding of the history long enough for me to get the basic ACLS stuff started and to page my resident with more to say than "please come save me." Even more fortunately, we were able to help the short term things with her. Long term, I have no idea if her apparent stroke will resolve. Probably, even knowing about her wouldn't have stopped all the craziness, but I would have been far more comfortable and would have lost less time.

I'm going to prepare more war paint.


Anonymous said...

Yeah. Had situations like that myself, in a much less acute realm, of course. my deepest sympathies. As i boil, all i can do is remind myself that the previous folk were overworked and thus could/did not take the time to do things right. This only consoles me a bit.


Anonymous said...

may i ask an unrelated medical question? i don't need a long reply -- just a few lines is fine.

One always reads that when a person has been hit on the head and knocked out / has a concussion, that he shouldn't be allowed to fall asleep; the surrounding folk try to keep him awake. Why is this, and is this accurate? Or is it just an old wives' tale?

thanks! :)


Nathan said...

As far as I know, there is little merit in keeping someone awake in such a circumstance. It is my understanding that more severe head injuries result in unconsciousness though, so perhaps the practice arises from that most indefatigable of human virtures: wishful thinking.