Straight Talk from the Stanford ER

One Stop Shop

2008-05-06T13:53:00.000-07:00

I went into emergency medicine because I wanted to be able to help any person and do it anywhere. The field offered a body of knowledge I could use to help any patient that might enter the emergency department. Of course, it did not take long to realize how much my ED care relied upon other specialists, nurses, medical devices, and the vast resources of the hospital. In a neighboring blog Paul...

Beyond Recognition

2008-04-02T14:21:00.000-07:00

She came to the Emergency Department, burned beyond recognition. She arrived in complete anonymity, and that is how she remains. I had just finished seeing a patient one early morning, when I heard the Paramedics enter the Emergency Room. I smelled her charred flesh, I heard her wheezing for every breath. This patient was supposed to be a "minor burn," as announced: they wheeled her past me, I...

Shot in The Dark

2008-03-01T19:00:00.000-08:00

“There is a sniper out there,” the paramedics stated matter of factly as they wheeled our patient into the trauma bay. “This is Jose, he is 25 years old, he was walking to the store this evening when he heard a loud ‘pop’, and felt a sting on the left side of his neck. He is bleeding from a small puncture wound over the lateral portion of his neck, and there is noted swelling. He denies any...

Attack of the Zebras

2008-01-30T15:40:00.000-08:00

An 80 year old mentor, and Physician once told me, “being a good doctor is not understanding the typical presentation of uncommon disease, but rather the atypical presentation of common disease.” I have tried to keep these words close as I have journeyed through Medicine…but it is difficult. We naturally want to gravitate, especially in Emergency Medicine towards the “Zebras,” or those disease...

Leap of Faith

2008-01-15T09:58:00.000-08:00

“Oh my God!” I exclaimed to my wife as we neared the restaurant. A nice day out with the family, driving to lunch, abruptly changed by our gruesome discovery. Our route had been rather fortuitous: I missed one turn, made another wrong turn, got stuck in traffic, then finally we neared the restaurant. I looked over casually…and there he lay, completely by happenstance: Half on, half off of the...

Why?

2007-12-09T15:16:00.000-08:00

“We should have known he was dying,” my Attending said to me with a somber look on her face. “These young guys always fight you when they are getting ready to die,” and that’s exactly what Rodney did-he fought us. One minute the picture of perfect health, the next, gone-his only memory the steady beep of a heart monitor, a trail of blood leaving the trauma bay. Rodney died in the operating...

Superman Sean

2007-12-06T23:53:00.000-08:00

I am using this title not only because I think Sean is one of my favorite and most impressive people to work with but also in an effort to instigate Sean into writing about his recent experience as a first responder to a trauma in downtown Palo Alto. In a sad turn of events, someone jumped from a building and landed right next to him. I'll leave that story for him. However, I do have my own...

Coming Soon: the Trauma Center 1.2

2007-11-15T15:44:00.000-08:00

We'll be hosting the next issue of the Trauma Center here next Tuesday, November 20th. The Trauma Center is a new blog carnival covering all aspects of emergency medicine. To be included, please send an email to lshevchik at healthline dot com by 12 midnight PST Sunday, November 18th.

A Stroke of Luck

2007-11-12T10:58:00.000-08:00

Last night, John was enjoying dinner with his wife. Suddenly he dropped his fork, a pain seared through his head. His right arm went limp, he tried to talk, but only incomprehensible slurs emerged. John at just 55 years old had suffered a massive, debilitating stroke. When he arrived at the Emergency Room a team of doctors and nurses had to quickly calculate if John was a candidate for a...

Too Many Chefs

2007-11-06T23:47:00.000-08:00

I am now in Los Angeles visiting my sister and her newly born daughter. Immediately after work I drove straight for San Jose and Southwest Airlines to see the first new member in our small family. The stark transition of my last two hours in the emergency room to the joy and hope I immediately encountered in the delivery room has left my head spinning. The ER blog about boarding brings me back...

The Trauma Center, 1.1

2007-11-06T13:32:00.000-08:00

Welcome to the inaugural issue of the Trauma Center, a blog carnival covering emergency medicine. I received an overwhelming number of submissions for our first time out and would like to thank everyone who sent in a submission. So without further ado, I bring you... Fat Doctor gives us a crash course in Japanese in this moving post about the benefits and limitations of virtual critical...

Part II: Where Do We Go from Here?

2007-10-31T16:07:00.000-07:00

...I prescribed Frank a potent steroid cream to help with the inflammation, as well as a moisturizing cream, and wrote down strict instructions as to how to care for his diseased skin. We gave him a list of free clinics in the area where he could be followed for his condition. “Frank, these medicines will cost about $30 dollars, but should last you for a couple of months….” “Thanks Doc he...

Where Do We Go from Here?

2007-10-14T10:52:00.000-07:00

Frank is an uninsured patient. I have seen him 4 times in the past 12 months for his chronic psoriasis-an autoimmune disorder which causes a thickening and irritation of the skin. His feet and hands are thick gloves of matted, cracked, peeling skin, which bleed and cause him a tremendous amount of pain. Even individuals with the best health insurance may have a difficult time dealing with this...

Thank You Grand Rounds 3.53

2007-09-25T14:18:00.001-07:00

Thank you Kevin M.D. for including D.O. Sean Donohue's What If... post in the fourth anniversary of Grand Rounds.

Another Ordinary Day

2007-09-06T13:58:00.000-07:00

“Doc this thing is stuck in my finger!” I was in the last hour of a 12 hour shift at Stanford University Hospital. Exhausted, I was hoping for a nice easy sliver, or laceration. As I looked down at Mr. J’s finger, I was shocked at what I saw: an Epinephrine Pen lodged in his thumb. Over the past 2 years at Stanford I have been mentally and physically training myself to be able to deal with any...

Thank You .Parallel Universes. for Grand Rounds 3.50

2007-09-04T11:39:00.000-07:00

Thank you .Parallel Universes. for including Sean Donohue's post Saving Lives in Grand Rounds 3.50.

Saving Lives

2007-08-22T21:39:00.000-07:00

I knew it was going to be a long night. It had to be. The blood still poured from his ear. I had been working nights in the Surgical Intensive Care Unit (SICU), and our new trauma patient had just come to the floor. As I sat with Patrick watching the blood pour in, and pour out, I thought about his choice, his life. Patrick had two choices, to hold on or to let go. He chose to let go, a decision...

Thank You Eye on DNA for Grand Rounds at the Beach

2007-08-07T11:46:00.000-07:00

Thank you to Dr. Hsien-Hsien Lei and Eye on DNA for including Dr. Anil Menon's post "Drugs of Abuse" on Grand Rounds at the Beach.

What If.....

2007-07-31T21:36:00.000-07:00

The Emergency Department can be a very hazardous place to work. Over the course of one year I have seen random acts of violence, and have had friends exposed to various bodily fluids. I have seen a meal tray thrown at a nurse and unruly patients take swings at ER personnel, in fact one of my fellow residents was attacked and bitten by a patient in the hallway of a San Francisco hospital. Although...

Drugs of Abuse

2007-07-30T06:34:00.001-07:00

To pick up where my last post left off, I thought I would write about a more common case than LSD. That would be alcohol intoxication. SFGH's director of Emergency Medicine, Alan Gelb, noticed a decade by decade decline in LSD presentation to the ED but a consistent stream of alcohol related illness. Now that I look back at the past month at SFGH, I can hardly estimate the multitude of medical...

Pandemonium

2007-07-11T15:33:00.000-07:00

"Fractals, fractals inside of fractals, and Asian doctors guarding the gates to eternity, little prisms, little prisms of gnomes, multicolored gnomes surrounding me, doctors with the keys, the key to eternity." I'll never forget those words that wished me goodbye as I left the hospital. The launch of my second year as an EM resident began at San Francisco General Hospital and did so in...

If a Tree Fell in a Forest...

2007-06-29T09:19:00.000-07:00

Mrs. B fell at her home 5 days ago. She was brought into the Emergency Department after a neighbor found her lying on the kitchen floor - she had failed to show for church bingo the night earlier - she had not missed that in 9 years! The paramedics brought her into room 13 on a gurney, she was still wearing her nightgown from the night of the incident. Mrs. B explained that she awoke the night of...

Another Late Night

2007-06-10T04:59:00.000-07:00

In the days following my last post I have worked successive night shifts. I even voluntarily switched into someone's night shift to keep my string together. Today is my first day off so I went to a party with my sister, a party that ended long ago, bringing me to my topic sentence. I can't sleep. As a result of last week's schedule only a raging party would have made me feel normal. Because...

Not Every Case is a Trauma

2007-06-01T18:05:00.000-07:00

It is 5:25 AM, Kaiser Emergency Department, and to my surprise I have time to write this blog. That means that all of our patients have been discharged--for a moment at least. This also illustrates that not everyone that comes through the door is a trauma. I thought it might be interesting to write a blog about a seemingly non-intense case to paint a more realistic picture of the emergency...

Who's Trauma is it Anyway?

2007-05-22T19:21:00.000-07:00

My last day as a resident at the Stanford emergency department fell on a Friday night. With only a few hours to go before the 7 am change of shift and I began slowing down. In a matter of seconds that tiredness snapped away as I listened to the radio call from the EMTs, "We've got two 16 year old females, ejected from their car, travelling at speeds over 100 mph, one is combative, we are seven...