Mostly Quiet Night The last 4 or 5 nights that I worked had been very busy so it was nice to have a mostly quiet night last night. I only did one case and it was done by 0130 in the morning. A lady came in for a laprascopic appendectomy. These are usually fairly simple straight forward cases. I have probably done a couple hundred of them over the years. There was one small complication with this case. The lady was 16 weeks pregnant. Fortunately as long as I know that ahead of time pregnancy is not a real problem. There are several of the medications that we use in anesthesia that could hurt a developing fetus. Anesthesia is like cooking, there are always other Ingredients that can be used. As long as I avoid the potentially harmful drugs the anesthetic is easy. The baby goes to sleep as the mom does and wakes up when she does. It is when we don't know that the women is pregnant that it can become an issue. That is why any female between the age of 10 and 50 who has not had a tubal ligation or hysterectomy is given a pregnancy test prior to surgery. I have had several cases over the years that had to be cancelled at the last minute when the pregnancy test came back positive. In one case the teenage girls parents had not known she was sexually active, it was not a pleasent scene. The pregnant ladies appendix was easily removed and she did just fine.

Busy Nights I have worked the last two nights and as usual on the weekend they have been busy. Friday night I did a case with a young man with multiple gun shot wounds. Actually I should say we did the case as we had 5 anesthesia providers working on the case when we started. By the time we were finished the young man had lost 9 liters of blood. We had given him about 35 units of blood products and other fluids. He should recover. Last night I did several interesting cases. The first involved a man who had back surgery about two weeks ago. Unfortunately for him the incision site had become very infected. Now any infection is bad but infection in bone and in this case in the spine is very bad. It is very hard to cure because bone doesn't get much bloodflow so it is hard to get the antibiotic to the infection. In this young mans case after I put him to sleep the surgeons opened the incision and washed it out. They use a device that looks like a large water pistol. It shoots water into the wound like a garden hose and suctions it back up at the same time. They used about 12 liters of water to wash out the wound. Before closing the wound they placed several strands of antibiotic beads into the wound. These beads look like strands of pearls and will slowly leech out antibiotic right at the site of the infection. The beads will be removed at a later date. My last case of the night was a very lucky young man. He had been stabbed in the neck with a broken beer bottle. The wound was about 4 inches long and laid open to the bone. Fortunately for him no major blood vessels or nerves were hit. Had the wound been towards the front instead of the back of the neck it would have hit the carotid or jugular and he probably would have died within minutes. I have one more night to work tonight. If I do anything interesting I will try and blog about it tomorrow.

Organ Donation I Went in to work last night to find out that there was an organ procurement case to be done. I immediately started feeling bad because that meant that in the ICU was a patient who was brain dead. They may have been in a bad car accident or a drowning or some similar accident. There was probably a grieving family as well. I have done several of these cases over the years and I have never liked them. Now don't get me wrong. I think that anyone who decides to be an organ donor is a hero. I have done many transplant cases over the years. It is really cool to see them place a kidney in a person and watch it change from a dull tan to a healthy pink color when the surgeon starts the blood flow to it. Then to see it start to produce urine before I can even wake up the patient. The organ procurement case is different. The patient arrives like any other case from the ICU. They already have a breathing tube in and I hook them up to my monitors like any other patient. I monitor their vital signs, give meds, make adjustments just like any other case. The goal is to maintain oxygenation and circulation to the heart, lungs, Kidneys and other organs until the surgeons can remove them. That is when things get different. Once the major organs are removed I am no longer needed. Things like corneas, bone and skin are also taken for transplantation but they don't require that the patient's vital signs be maintained. Once the major organs are removed I turn off all my monitors and leave the room. It just doesn't feel right to leave the room without taking the patient to the recovery room. I will never get used to that. It turned out that because they were waiting for a transplant team to take the lungs they didn't start the case until I was leaving for home this morning. I would be lying if I said I wasn't a little relieved that I didn't do that case.

Guys and Dolls! Thumper and I went with my parents to see the boy in the musical "Guys and Dolls" yesterday. It was really good. The singing was good and several of the dance numbers were outstanding. The choreographer of the show was in the same Actors Training Program as our son and she is obviously very good. One scene has a couple of the main characters in a latin club in Havana. They are sitting at a table while a floorshow of latin dancers moves around them. Our son was one of the dancers. He danced with several different partners a dance that was part Tango, part Cha cha with a mix of other things. It was great. This was also the first time that his Grandparents had seen him in a show and they were very impressed. My father told my son that "he must have gotten his singing and dancing talent from him!" We all went out to eat afterwards. My only complaint is that seeing this show made me remember when I was in Guys and Dolls years ago in High School. Our production was no where near the quality but the songs were the same and now I am going to have those songs stuck in my head for weeks!!! The show goes on for one more weekend and Thumper and I may try to go again next sunday.

Days Off After working four long nights it is nice to be off. We have been just taking it easy. We might go see a movie today. Maybe Charlie and the Chocolate factory. We would like to be able to take the convertible out for a ride but we are currently in the middle of a heat wave here. It has been 100-104 degrees here the last four days with no relieve predicted for at least several more days. They say on the the air quality isn't very good either so if we go anywhere we will leave the top down and the air conditioner on. This Sunday we get to see the boy in Guys and Dolls. It will be nice to see him in a play especially that one. Many years ago in High School I had a small role in Guys and Dolls. It will be nice to see it at a higher than High School level of production. My parents are coming down for the day to see it as well. This will be the first time they have seen the boy in anything so it should be a good time for all

Can You say Trauma? One of the things about working the night shift is I get to see a lot of Trauma cases and the last three nights have been no exception. I already blogged about the gunshot wound to the chest I did Saturday night. On Sunday night I did another gunshot case. This person had gun shot wounds to both of his legs. The bullet in his left calf had broken his leg but it was not a bad break. However the bullet that hit his right leg severed one of the major veins near his knee. He nearly bled to death before he got to the hospital. By the time his 4 hour surgery to fix the vein was completed he had recieved 8 units of blood as well as lots of other fluids. Fortunately he was young and healthy and should recover fully. Last night I did a case involving a man who had been repeatedly stabbed. He had 3 stab wounds in the front of his chest, 4 more in his back. He had several wounds that went to the bone on the top of his head. I do not know the details of who or why he was stabbed but someone really tried to kill this man. Fortunately he did well in surgery and will also recover. I have one more night shift tonight and then I am off for a few. Hopefully tonight will be quieter than the last three.

Interesting Case Had a interesting case last night. About 3 in the morning they brought up a young man with a gun shot wound to his upper chest. The bullet had entered the left chest above his heart and exited out his back. Fortunately it did not hit his heart or major blood vessels but it did hit his left lung. He already had a endotracheal tube (breathing tube) in place and seemed to be stable. In the operating room he was quickly asleep and turned onto his right side. Everything was going well, the surgeons made a large incision that started in the front and went around to the back to expose the lung. Once his chest was open we had a problem. The bullet had made a large hole in his left lung. Because of the air leak caused by the bullet hole I started having trouble ventilating the patient. It was like trying to blow up a balloon with a big hole in it. The patient's oxygen level started to drop as I tried to ventilate him. The surgeons covered the holes with their hands and I could ventilate him again but everytime they moved their hands to work it became difficult again. Normally when I put in a breathing tube it goes in through the mouth(or nose) and passes through the vocal cords into the lungs. A few inches past the vocal cords the trachea splits into two branches, one branch going to the right lung and the other going to the left lung. The tube is placed so that both lungs are ventilated. A mistake that can be made when placing a breathing tube is to put it in to deep causing it to go into the right branch. This causes you to only ventilate the right lung and not the left. When I put in a breathing tube I always listen with a stethoscope to be sure I hear breathing sounds from both lungs. In this young mans case I ended up pushing his breathing tube into his right lung on purpose. This allowed me to ventilate his right lung keeping him alive while the surgeons were able to repair his left lung. At the end of the case I returned the breathing tube to the normal position ventilating both lungs and moved the patient to the ICU. He should fully recover.

Lucky Me! Well I got through the night of the 4th without a lot of cases. I guess it was my time to be lucky becausetuesday night I ended up doing nothing all night until I started a case about 5 in the morning and was relieved by the dayshift at 6. Last night was even better as I did not do any cases at all. For a traima center it is pretty rare to go several nights in a row without a single trauma case. I wouldn't want it like that all the time but an occasional quiet night to listen to my ipod and read my book is kind of nice. I am on again this weekend and will probably be a lot busier.

Mostly Quiet Night It turns out I was wrong about last night, fortunately. I had to work last night and it being the 4th of July I thought we would be busy all night. Between fire work accidents (I have seen some ugly wounds caused by fireworks over the years) and drunk drivers I figured I would spend all night doing cases. I did one case involving a young man who got mugged and stabbed in the abdomen. Fortunately other than an easily repaired liver laceration nothing else was injured. The case went from about 2300 (thats 11 pm for you non military types) to about 0100 in the morning. Other than that it was a quiet night! I was very pleasantly surprised. Two more nights to go. Hopefully they will also be quiet.

Happy 4th of July!! Hope everyone has a happy and safe holiday. I have to work tonight and hope we don't get any fireworks injuries though I will not be surprised if we do.