Busy Weekend We can always tell when the weather starts improving on the nightshift. The number of traumas go up. This last weekend turned out be a busy one. On Saturday night a 20 something year old man was brought up with multiple stab wounds in the back. He already had a breathing tube in place. His heartrate was around 140 and his blood pressure was low which is a sure sign that he had lost alot of blood. When the surgeons opened him up they found his left kidney was almost cut in half and was bleeding profusely. They quickly clamped the artery going to the kidney to slow the bleeding. They determined that his kidney was unsalvagable and removed it. He also had severe damage to his large intestine. They removed part of his intestine and created a colostomy. He will have to deal with a colostomy bag for 3 to 6 months before further surgery can be done to reconect his colon. I gave my patient 18 units of blood products to replace what he had lost and left the breathing tube in place at the end of the case. Hopefully the breathing tube can be removed in 24 to 48 hours. Sunday night found me taking over a case with another young man with multiple stab wounds to the abdomen. The surgeons had to repair several holes in his small intestine. He should make a full recovery. The second case of the night wasn't technically a trauma. A 69 year old man was rushed to the operating room after vomiting blood. It turned out that he had an ulcer that was bleeding profusely. He had already recieved 6 units of blood in the emergency room. I gave him about 10 more in the operating room. The surgeons said he actually had three ulcers, but only one was bleeding. The surgeons felt that overuse of NSAID medications had caused his ulcers. NSAID drugs include aspirin, motrin and naprosyn. These are all hard on the stomach especially if taken on an empty stomach. I did a few other routine cases over the weekend as well.

MMMMMMMMMMM Beer!!!! I don't remember if I have mentioned before that I like to make homebrew beer. It is not terribly difficult to make once you invest in the necessary equipment. It starts with a 4 gallon pot in which malt, grain, sugar and other ingrediants are boiled for about an hour or so. The boiled mixture is cooled, placed in a 5 gallon plastic bucket into which yeast is then added and sealed. The yeast consumes the sugars and produces alcohol and carbon dioxide gas. The gas escapes the sealed bucket through a special one way valve. After about a week the partially fermented beer is transfered to a five gallon glass container called a carboy. Depending on what kind of beer you are making it can stay in the carboy for anything from 10 days to 6 months. Finally the almost finished beer is carefully siphoned into another five gallon plastic container. A small amount of sugar is stirred in and then the beer is carefully siphoned into bottles and sealed. The remaining yeast eats the little bit of sugar and the released carbon dioxide gas carbonates the beer. In about 2 weeks the beer is fully carbonated and ready to drink. About 2 weeks ago I started a batch of cherry wheat beer. I will probably bottle it in another day or two. Each batch usually makes about 50 twelve ounce bottles. I made a batch of raspberry wheat beer about a year or two ago that turned out really well (the boy and his friends really seemed to like it). Tonight I cooked a batch of "old Mexico" beer. I have made it before. It is like a full bodied Corona. Of course if you make beer it logically follows that you must occasionally drink a beer. Drinking one is almost as much fun as making it.

The Weekend So Far It is just after 3 in the morning as I write this. I am listening to some music here at work as I write this. I have the country group Whiskey Falls on first but am going to follow that with a cd by Vanessa Mae. She is a 20something year old who does amazing things with a violin. This is my second of three nights at work. Friday night was quiet with only 1 short case. A 52 year old woman came in with an abscess on her hip. The abscess was caused by her use of a dirty needle to inject herself with heroin. She has a history of multiple abscess surgeries and sadly we will probably see her again sometime in the future. As I arrived to work tonight the evening shift was working on a 20 something year old man with multiple gunshot wounds to the abdomen and chest. He had lost a lot of blood which was being quickly replaced when I arrived in the operating room. I helped out as needed but it was not my case. They left his breathing tube in at the end of the case and took him to the ICU. He had recieved over 20 units of blood products. When a patient has a high blood loss and massive transfusions it usually causes a significant reduction in their bloods ability to clot properly. In some cases this can cause the patient to resume bleeding within a few hours of their original surgery. In this case we ended up bring the man back to the operating room several hours later with further bleeding. The surgeons removed about 1000 milliliters of blood from his abdomen while I gave him another 10 units of blood products. We took him back to the ICU an hour ago. Hopefully he will not need any more work done tonight. Well Whiskey Falls is done I am going to put Vanessa Mae on now and sit here wishing I could play the violin 1/10th as well as she does.