Friday, May 27, 2011

Turf the Bear!

There is a stash of small stuffed animals in the back room of the ER that we give out to young children or physicians who are scared of getting their employer-mandated flu shots. (This is why I have a new giraffe named Bob). So it's not unusual to see these toys floating about the nursing station. But what was strange was finding a stuffed bear with a tear in the joint between its head and neck taped to a clipboard and stuck in the "To Be Seen" rack with a note on the chart that says "Help me, please...I'm losing my head!"

This prompted a discussion of the best plan of care for the small smiling ursine. While we can and do sew up lacerations, the location of the tear and the extrusion of fluff from the rent suggests the possibility of deeper injury that goes beyond my expertise. In fact, as the bear does not react when I talk to it, nor does it have effective movement of its limbs, severe head and spinal injuries might be present. Maybe he needs transfer to a neurosurgeon:

"Hi, Dr. Smock? Hey, it's Howard Rodenberg out here in the ER. I've got a patient I hope you can give me hand with tonight. His name is Theodore Bear...last name's B-E-A-R...and he's an unknown aged male with a large laceration to the back of the head, almost like someone tried to decapitate him. When I first saw him his eyes were open but he was unresponsive, not moving his arms and legs, and not reacting to voice or pain with an overall GCS of 6. So far I've got a CT of the head which shows only a "white-out" homogenous pattern with obliteration of the normal anatomical landmarks that radiology is reading as diffuse cerebral edema with increased intracranial pressure. I've tried to intubate him for airway protection and hyperventilation but I'm unable to get his mouth open to intubate him despite using's like his mouth is sewn up tight. I've tried to get a nasal tube in him instead, but I keep meeting resistance and can't get it placed. That being said, his vitals have been unchanged throughout his ER stay. I'm thinking that because we're having airway problem, it's best to get him there by air. We'll make the arrangements with the helicopter if that's okay with you."

You don't know how much I want to make the call, because I'm nearly positive that if I talk really fast at three in the morning I can probably pull it off. I probably would do it, too, but neurosurgeons generally have the same sense of humor as Newt Gingrich. Oh, wait...that's wrong...heck of a prank he pulled off last week about that whole Presidential thing. Well, played, Mr. Speaker...well played.

No comments:

Post a Comment