Friday, August 17, 2012

Bloody Assumptions

A woman dressed in all white rushed in and slapped her hand on the triage counter to get our attention.
"My husband! I need to see my husband!"
S: "Ok, let me look him up in our computer to see where he is."
"Hurry, this is an emergency!" And she burst into worried tears.
S: "It looks like he is not in our system yet. Did he come in by ambulance?"
"Yes. I can't believe you won't let me see him."
S: "Please try to be calm ma'am, you actually arrived before the ambulance did. What is he coming in with?"
She tearfully listed an extensive list of cardiac surgeries and history, his passing out at dinner, and that he had "stopped breathing twice." The triage nurses and I looked at each other- this sounded bad. We looked up to see him coming into our ambulance bay, and Ms. Hypochondriac ran to his gurney.

I followed her, and saw, with horror, a vomit basin filled with bright red foamy stuff. I've seen bloody CHF spit-up before, and this looked just like it. He groaned and seemed weak so the triage team expedited him to critical care before even getting his history.
I brought him into the room and helped the critical care team immediately undress him, take an ekg, and put him on our monitor system, gingerly removing the large red-filled basin to a biohazard bin. Upon looking closer at the bin, I froze. What were those little granules?

I asked Ms. Hypochondriac if it was blood. "Oh, goodness no, he raspberries right before we arrived."
I stared at her blankly as it began to register. "He ate such a big bowl," she added with big eyes, as if eating more would have made a big clinical difference.

Raspberries! Such a big fuss over vomited raspberries!
It was not blood in the basin, which I verified with a gastroccult. I could barely leave the room without letting Ms. Hypochondriac see the grin on my face. I don't think she could have appreciated it.

Working in the ER, we are so hyper-focused on the worst-case scenario that it is sometimes hard to see the most obvious (and comical) possibilities.


1 comment:

  1. I used to work as a medic. I only had two true "saves" in 8 years.

    The second "save" had collapsed in front of his girlfriend after dinner. She, an RN, promptly initiated CPR, and only 1 defibrillation from us was required to return a sinus rhythm.

    He still required intubation, but his mental status improved so quickly that he fought and bit at the laryngoscope, and I retreated to BLS airway maneuvers. Just before arrival in the ED however, he started vomiting and coughing - of course - some bright red liquid.

    As we rolled into the ED I was sodden with guilt, sure that I had lacerated the carotid airway, and certain airway disaster was commencing.

    I knew I couldn't "spin" a traumatic intubation to the RN girlfriend, and I immediately confessed to her that my efforts had likely caused significant damage. I prayed that my straight-forward candor would redirect her justifiable anger.

    "That's Jello. We just ate some red Jello."