#EMERGENCY MEDICINE

[tumble-tv]

Going to a protest? Bring first aid.

I don’t mean bandaids and acetaminophen (although those are helpful). I’m talking trauma first aid. I’m talking gunshot wounds and car accidents and stabbings, stuff to keep somebody alive long enough to get to the hospital. Because it happens, and you need to know what to do if and when it does.

You need an IFAK (Individual First Aid Kit) pouch. You can find them easily online, this is my favorite model. No clasps, no buttons, just pull and it’s open. You don’t want something that will take a long time to open or something that has seventeen pockets. Everything needs to be in one place and easily accessible.

Here’s what you need in that pouch:

Tourniquet (https://www.rescue-essentials.com/combat-application-tourniquet-cat-gen-7/) This is how you keep people from bleeding out. Relatively easy to use, there’s plenty of videos online on how to properly use them. When somebody is shot in an arm or leg and is bleeding out, you need to use this or they will die. You can keep this on a limb for about six hours before there’s any risk for amputation, so they’ll be fine. Have one easily accessible on the outside of your pack and another inside your bag. Two is a safe number, but the more the merrier. Don’t cheap out on them, either, you need something that will hold up and do what it needs to the right way. Bright colors are your best friend here, use them. Black may look cooler, but it’s harder to see. Neon orange will always be your friend in the medical field. You can also write a “T” on the person’s forehead to let medical professionals know that they have a tourniquet on.

Trauma Shears (https://www.rescue-essentials.com/north-american-rescue-trauma-shears/) Somebody gets shot in the upper leg? You need to cut their pants off and this is what you’re gonna do it with. No time to waste with taking them off the normal way, get to cutting. Sorry, but their jeans are not top priority at the moment, their life is. I like to get mine in a color that I can easily recognize, like orange or glow in the dark green. Makes it easier to find.

Nitrile Gloves I’m talking medical gloves, the blue ones. You don’t want black because you can’t see blood as easily with that. You want blue or green. Keep multiple pairs (I personally have a handful just shoved in mine), because god forbid you’re working on multiple people, you NEED to be able to change gloves so you don’t cross contaminate their blood with each other. That can lead to so many problems. This protects both you and them from any contagions on your skin or in their blood. You can honestly get these at any store, but please get them allergen friendly (latex free). Keep them in their own little baggie to prevent contamination.

Sharpie When you apply a tourniquet, there’s a little white piece. You need to write the time you applied the tourniquet on that little strip. Worst comes to worst, if you forget your sharpie you can use blood to write on the person.

Compressed Packing Gauze (https://www.rescue-essentials.com/nar-responder-compressed-gauze/) If somebody has a deep wound like a gunshot wound where you can’t use a tourniquet (chest, back, stomach, etc), you need to use this. Find where the blood is coming from and shove it in there. You can get hemostatic packing gauze with a clotting agent, but it can be a bit expensive. Apply pressure, it’s a game changer. Also, if you’re using a clotting agent, keep the package to show to the medical professionals.

Compression Bandage (https://www.rescue-essentials.com/israeli-t3-bandage-4/) Also known as an Israeli bandage (I know, that’s just what it’s called and referred to). It ahs some plastic on it so you can wrap it around and twist the plastic piece to apply as much pressure as possible. Theta aren’t overly common, but they’re good to have. Perfect for slowing bleeding or securing a bunch of gauze you packed into a wound that you don’t want to move.

Nasopharyngeal Airways (NPAs) (https://www.rescue-essentials.com/rescue-essentials-naso-airway-kit/) Basically a tube you slide down somebody’s nose to keep their airway open. Best for if somebody has significant trauma to the jaw or mouth. Always use the lubricant!!! If you don’t, this becomes so much harder to do and so much more painful.

Vented Chest Seal (https://www.rescue-essentials.com/hyfin-vent-compact-chest-seal-twin-pack/) For a penetrating wound to the chest like a bullet, use these. One for the entry wound, one for the exit wound. These let trapped air to escape, but don't let air come in.

Space Blanket (https://www.rescue-essentials.com/nar-survival-blanket/) You know those funky silver blankets that look like tinfoil? That’s it. When somebody goes into shock, their body temperature will drop significantly. They can literally go hypothermic in ninety degree weather.

Rat’s Tourniquet (https://www.rapidtq.com/collections/tourniquets-1/products/r-a-t-s-tourniquet) Sometimes a regular tourniquet is too bulky. Maybe somebody is super skinny or it’s a kid or an animal, this will stop blood flow when a regular tourniquet won’t. They’re a little harder to figure out, but they’re worth it.

Other Helpful Stuff

Bandaids

Regular old sterile gauze

Alcohol pads

Neosporin

Sealed water bottles for washing out wounds if need be

Medical tape

Rolls of sterile gauze

Antiseptic

Tweezers (DO NOT GO DIGGING AROUND FOR BULLETS THIS IS FOR NASTY SPLINTERS)

Penlight

Glucose gel for all of our hypoglycemic friends

Blood glucose monitor to test if need be

Pulse oximeter

Shit ton of eye drops for tear gas, because that stuff hurts

Superglue

Masks

Hand sanitizer

Rubbing alcohol (Can be substituted with drinking alcohol if need be. Find the highest ABV you can, vodka and whiskey are your best choices here.)

Hydrogen peroxide

Electrolyte packets/chews

Bandanas

Eye protection, like goggles

Something to make a splint with. You can use an actual splint (https://www.rescue-essentials.com/sam-splint-original-36/) or any long rod or stick, really.

Duct tape

Multi tool and/or pocket knife

If you’re going to be That Guy in full tactical gear, make sure people know which side you’re on with patches. Pride flags, ACAB patches, whatever it is, put them everywhere. Make sure the people around you know which team you play for.

Buy multiples of everything. Make sure you practice and know what you’re doing. Have a bigger bag than that pouch I linked above? Great! Shove more stuff in there, the more the merrier.

Take a Stop The Bleed course, that makes everything easier and you’ll be better at what you’re doing. They’ll teach you how to pack a wound, you’ll stick your fingers in a fake leg and learn to do it. Also take a CPR course and get certified. I believe they teach you how to use an NPA, but I’m not entirely sure since I took one for my EMT certification and was taught to use NPAs, but I know that EMT certification for CPR is different from civilian certification in some way.

I did not include CPR materials for a reason. If somebody is passed out from massive blood loss, they won’t wake up with CPR. If there’s no blood for the heart to pump, then CPR won’t do anything. If someone isn’t breathing and this is a mass casualty event like what this bag is packed for, leave them. I hate to say it, but you need to leave them. There is no way you are going to get this person breathing again in time for you both to get out alive if you’re being shot at. If somebody needs CPR, they are classified as “meaningfully dead.” CPR is meant to keep blood moving until first responders arrive, and during protests, they won’t. You’re free to bring CPR materials, I won’t stop you, but be aware of that.

Tampons are a good emergency alternative to packing gauze if need be. You’ll probably need a lot of them, but they’ll work in a pinch (and will be awesome if somebody needs one for their normal purpose).

If you have anything to add, please do. Any information helps.

[rebeccathenaturalist]

This FB post (which was public at the time I grabbed this screenshot) is Reason #90510 I teach nature identification classes and am SO adamant that my students look at ALL the details of a given animal/plant/fungus. Also, I ran the photo through iNaturalist just for the heck of it. Its first suggestion was timber rattlesnake (Crotalus horridus), but its second was western rat snake (Pantherophis obsoletus). This is why you never, ever, ever use an app as our only tool for identification, because you need to also have the critical thinking and observation skills to be able to differentiate between species, to include when the app offers up two similar species where the difference can be a serious matter.

I hope the OP makes a quick and full recovery, because I can't imagine getting tagged by a venomous snake is much fun. Please skip any judgemental comments about Darwin Awards, etc.--I have seen plenty of intelligent people make bad mistakes, and have even made a few myself, though none with quite this level of consequence. It can happen to anyone; thankfully OP realized their error in time to get medical help.

[emgoesmed]

10/18/2024

Officially completed my first ambulatory block, next up is the ED just as respiratory season is kicking in; I'm nervous but excited to learn a lot.

[drdessertfox]

It’s been really interesting to see the turn medicine has made with the public over the past several years. I would never advocate that you should trust any physician blindly, but it’s quite amazing that those with GED level education are trying to convince others glucola is evil, the vitamin K shot is unnecessary, and that doctors order certain medicines and tests because “big pharma” pays them to do so.

I want to be very clear- as an EM physician I am paid hourly, much like all other EM physicians. I do have an RVU component meaning I make more money if I am more efficient but that is only a minimal component of my pay. I want to have conversations with my patients and help address your emergencies, but it’s incredibly difficult when I’m met with antagonistic attitudes from the start that stem from misinformation and fear mongering of online crunchy mom influencers.

[studyblr-of-a-biomed-student]

Working in the emergency department is just:

- Seeing 5 people with colds who shouldn’t be here

- Someone with diabetes who just chugged a Big Gulp Soda

- Mystery Abdominal Pain

- An old person who fell and somehow broke every bone in their body

- Seeing the happiest healthiest baby ever with parents who look like they haven’t slept in 3 days because the baby sneezed (I don’t mind these patients - cute baby, knowing the cute baby is cared for, and easing people’s worry? Great time)

- Someone who got in a car accident 2 days ago and just now decided to get checked out and is about to learn about whiplash

- Someone who didn’t try any OTC medication for their symptoms before coming and is about to get the most expensive Acetaminophen & Ibuprofen of their lives

- An interaction that changes your life; that leaves you with a deep sadness but also hope and a certainty that despite everything, in their hearts people are good and want to love one another

- A 3ppd smoker with diagnosed COPD who decided today is the day to figure out that cough they’ve had for 5 years

- Homeless people who just want to get out of the elements and have a snack you want to help but can’t

- Someone who will scream at you for not prescribing antibiotics for a viral infection

- Someone with 13 heart stents who vehemently denies any heart problems because “they fixed it!”

- Someone who just invented a new way to take medication wrong

[justkidneying]

Why the Spleen Sucks

The spleen is a really shittily placed organ, making it prone to injury. This injury is usually severe and can lead to death if not properly managed. We're going to look at the function of the spleen, what happens when it is damaged, and how to write about.

Where is the spleen? It's in the upper left quadrant of the abdominal cavity, nestled right against the ribs (typically 9-11) at the midaxillary line. It's behind the stomach and is considered intraperitoneal. The main thing is that the spleen is very vulnerable. It is literally right up against the ribs without much protecting it. It's shaped like a little bean and is purple in humans. It is fed by the splenic artery, which comes off of the celiac trunk (which sticks off of the abdominal aorta).

What does the spleen do? Its main job is to filter out old and malformed red blood cells. It also holds immune cells. Certain diseases can cause the spleen to enlarge, including cirrhosis of the liver (it's connected to the hepatic portal system), sickle cell anemia (RBCs are stuck in it), and autoimmune disorders. The spleen also holds about 250 mL of RBCs in reserve in case you need them.

What happens when it is injured? The spleen can be ruptured and lacerated kinda easily. Blunt trauma to the ribs can cause it to rupture, and this is seen in contact sports and car accidents mostly. Because of those giant gaps between the ribs, it's also prone to injury from knife attacks. Gunshot wounds are another common cause, as well as broken ribs penetrating it (broken ribs are very sharp, like way sharper than you imagine). Rupture is more likely when someone has splenomegaly.

When the spleen is damaged, you're going to get a lot of intraperitoneal hemorrhaging. The spleen filters a lot of blood and has blood in it, so there's going to be a lot of blood in the abdomen (obviously). This will lead to distention, guarding (abs are tense), and hypovolemia. The left upper quadrant will be painful, and there can also be referred pain to the left shoulder (Kehr's sign).

If the patient has a small laceration, the symptoms aren't always as dramatic. Sometimes they'll just have low hemoglobin (which is on RBCs), maybe some thrombocytopenia (lots of platelets in the blood).

How do you fix this? If the injury is small and the patient is hemodynamically stable, they can usually be given a blood transfusion and the spleen can heal itself. Sometimes surgery is also performed to clamp a vessel or repair the outer layer of the spleen.

If the injury is major, then surgery will be performed. If the patient is less critical, they may go in and try to fix the problem. If it can't be fixed, they may do a splenectomy (remove the spleen). In a critical patient, they might forgo the nice pretty incision on the left side, and instead just split the patient down the middle. In these situations (in my experience), there isn't a lot of time to waste. One thing that we aren't going to waste time on is anesthesia, for example. This is with a lot of very critical surgeries, at least from what I have seen. Like the surgeon will start cutting as they are working on knocking out the patient, but usually they are in so much pain that they don't even register it.

If you remove the spleen, the patient is more at risk for infections, but with modern medicine and vaccinations, it's not as much of a big deal as it used to be. The patient will probably be fine.

Writing tips: (new section idea, hope you guys like it, lol) As with any injury, you have to make sure that you are giving them an acceptable mechanism of injury. With the spleen, this is either blunt trauma or penetration/laceration. Getting tackled, getting stabbed, getting shot, all great MOIs.

Second thing, present the appropriate signs and symptoms. A sign would be like bruising, hypotension, tachycardia, etc. A symptom would be LUQ pain, Kehr's sign, etc.

Next, figure out what you're going to do and where you're going to do it. In the field, there probably isn't much you can do. The most would probably be a laparotomy and clamping the splenic artery, but I mean, when I was an EMT, we were not doing this. There's a lot of stuff you can theoretically do, but never gets done. But I mean you can write it. If the patient makes it to the hospital, I think it would be more fun to do emergency surgery and just split them right down the middle. There's going to be a lot of blood in the greater omentum, very high stakes and exciting.

Anyways, hope you guys liked this, please let me know if I got anything wrong. I wrote this off of my personal experience and a few good textbooks, but there can always been mistakes in things.

[heardatmedschool]

“My tummy hurts…. Sorry, my right iliac region hurts.”

[heard-in-the-emergency-room]

[help-im-a-medstudent]

Never trusting a "can I handover my patients to you, there's no jobs to do" ever again

"He's having a ct head I'm sure it's going to be fine, GP just needs to refer to memory clinic" the CT head was not fine, had to do a referral to neurosurgeons and tell a man and his wife he had brain metastases and probably some cancer somewhere else in his body

"Waiting for a troponin if it's normal they can go home" the troponin was not normal

"Just waiting for a bed on the ward, everything's done" continued vomiting, required discussion with surgeons, ct had to be arranged

"Ortho are on their way to review" ortho were not on their way, because the day team had not handed it over to the night team

[karmaalwayswins]

@quezify eggtober 2024

Nurse Kylie poked her head into the emergency department’s provider room. “Dr. T?”

“Yeah?”

“David wants you to come to room 12.”

“It’s a sprained ankle, he can handle that.”

“He already saw the patient, but he said you’ll need to see him too.”

Dr. T stood up from the computer and walked to room 12. David, the physician assistant, met her in the hallway across from the room. 

“Patient is Allen Spencer, age 29. He signed in for a sprained ankle. His xrays are fine, but when he opened up his bag… Well, see for yourself.”

The patient, a brown haired man wearing a sweatshirt and track pants, was sitting on the stretcher watching TV. Next to him was an approximately one foot tall egg with arms and legs. It was faceless. Neither the patient or the egg seemed to be in any acute distress. 

“That’s an egg who has arms and legs,” Dr. T said. 

“It is.”

On the TV screen, a football game was playing. A wide receiver caught a pass and started doing an end zone dance. The patient let out a little squeal and high fived the egg. The egg then stood up and started imitating the end zone dance. 

“It has no eyes but it can see.”

David passed her a notepad. “It asked for a pen and then wrote this.” 

On the notepad was a neatly written message in blue ink. Dr. T read it out loud in an annoyed voice. “Turn on the game.” She shook her head, then said, “This looks like an Institute problem. Did you check the guy for a chip?”

David answered, “I did. His scan flags for Spiceland Institute.”

“Did you call them?”

“Figured I should let you see him first.”

“Does he have any complaints other than his ankle?”

“He’s fine other than that.”

“OK. I’ll check his ankle just to say I did. Call the institute so they can come and get him and his egg. Get a sitter for the room until their team shows up.”

Dr. T. entered the room. “Hi Mr. Spencer, I’m Dr. T. They told me you hurt your ankle.”

“I twisted it in the woods.”

“I’ll take a look at it. Who’s your friend here?”

“He’s Buddy. He likes football.”

“Let’s have Buddy sit in the chair while I look at your ankle.”

The egg athletically jumped down off of the bed, walked over to the chair, turned the chair to face the TV screen, and then climbed into it to sit. Dr. T raised her eyebrows as this series of events occurred, let out a breath, and then started looking at Mr. Spencer’s ankle.

“I barely see any swelling here. Can you bend your foot up and down for me? Good. Wiggle your toes. Good.” She stood up. “I’m going to go talk to PA David. You can just rest for now and watch the game. OK?”

“OK.”

When she exited the room, a panda-man wearing scrubs was stationed in a chair next to the door, on sitter duty. His arms were crossed over his broad chest. He nodded his head and asked, “How you doing, Dr. T?”

“Depends on how much paperwork I have to do about this,” she said. 

She walked over to Helen, the charge nurse. “You’ve got Tai Shan doing sitter duty?”

Helen shrugged. “He’s trying to buy a house. He needs the extra hours.”

A couple of hours later, staff from Spiceland Institute arrived. Dr. T shook hands with the two men, who were wearing black baseball hats and black jumpsuits.

“I’m Dr. T.”

“Specialist Allen Kemper.”

“Specialist Dale Chavez. I gave your charge nurse the transfer paperwork. Can I get your name for our records?”

“First name’s Wendy, with a Y. I’ll just spell my last name. T-A-P-A-Z-O-C-L-O-L-I-N-E-A-B-E-U hyphen D-I-A-Z.”

“Got it. We’ll take him off of your hands.”

“And the egg?”

Specialist Chavez rolled his eyes. “We’ll take the egg too. The two of them are kind of a package deal. We've been looking for them for the past day and a half.”

Specialist Kemper cleared his throat.

Specialist Chavez shifted his eyes in response, then asked, "Which room are they in?"

"Room 12," Dr. T answered.

Specialist Kemper was helping Mr. Spencer into his coat when Dr. T went back into the room with the discharge paperwork.

Mr. Spencer was talking. “I watched the football game. And I had two cookies!”

“Two cookies are better than one cookie,” Specialist Kemper said.

Mr. Spencer asked, "Did you notice that it gets dark earlier now?"

"I did," Specialist Kemper answered.

On the floor, Buddy the Egg was enclosed in a carrier. By body position, he seemed forlorn. 

As the Spiceland Institute team walked out with Mr. Spencer and Buddy, Tai Shan glared at the specialists from his chair. 

Helen came up to Dr. T. “We’ve got a cardiac arrest coming in five.”

“What bed are you going to?”

“Thirty-four.”

“OK.”

[er-cryptid]

Common Medical Emergencies

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[tumble-tv]

You know what sucks? Taking a six month class to become an EMT, becoming fully certified, the whole deal, just to watch my health plummet into being a barely functional person.

I got certified in May. My body doesn't work enough for me to be confident that I can save someone. It's been two months and it's only gotten worse.

My dream of being an EMT, of saving people, of finally being the person to help is crushed because my body doesn't work like it should, and it's tearing me apart.

I don't know what to do.

[equinesandeducation]

Packed all my stuff for my first overnight/stand-by shift. Because I live far away from the faculty and you need to be at the clinic in 20 minutes for a stand-by, I get to sleep at the Farm Animal Clinic! Almost feels like a little holiday, with the exception of getting called in the middle of the night for emergency surgery.

[emgoesmed]

11/2/2024

Tb to when I had time to read books for fun, just a month ago 🥲

Flipping back and forth from nights to days to nights in the emergency department while also trying to study for step 3 is not something I recommend 😭

[lesbiansandgayssupporttheminers]

Mother, 39, collapsed under her coat and died after seven-hour wait at crowded A&E - LBC

This should not be happening.

We used to have a functional NHS - maybe there were issues but in emergencies it functioned.

The Tories have destroyed that.

[studyblr-of-a-biomed-student]

So working in emergency medicine is going well…