(Disclaimer: There is significant medical jargon in the next few paragraphs. Don’t worry too much with the details if you don’t understand, but as a general rule, all the numbers I mention are bad.)
The pace of a single coverage ED can be incredibly variable. There are times when the department is entirely empty, but others when it can feel like it’s bursting at the seams. A single coverage ED in a town that hosts an annual Ironman, motorcross races every month, and more trialthalons and duathalons and road bike races than I can keep track of, can be a beast all it’s own.
The idea of a “sleepy” little ED is, therefore, a bit of a myth. For example: recently it was motorcross weekend. They race all age groups from 6 years and up. We saw the typical extremity sprains and fractures.
And then ended the day with a blunt chest trauma resulting in a tension pneumothorax and hemothorax and respiratory failure. He rolled in nearly obtunded with pulse ox of 80% on a non-rebreather. I did a needle decompression, intubation, and chest tube in about 15 minutes thanks to an awesome team of nurses. In the battle of motorcycle vs chest, motorcycle remains undefeated.
The day before that, I had a young lady show up with palpitations. She also had chest tightness, was lightheaded, and had a heart rate of 170. ECG showed a. fib and her blood pressure
was 83/41. Oh by the way, she was 38 weeks pregnant. I checked some fetal heart tones (140, thankfully) and talked to OB/GYN while I had the nurses set up some sedation. After 50mg of propofol, I hit her with 50J of electricity and peed my pants just a little. Fortunately it worked and she was back in a normal sinus rhythm with no more chest pain or lightheadedness. Take home lesson number one – it’s always bad when the fetus has a lower heart rate than the mother. Take home lesson number two – electricity is almost always the right answer. Let’s hope that baby doesn’t remember me.