Found this little gem of a video on my favorite college football blog, Every Day Should Be Saturday, it shows the effects of PCP on a young, stupid human, and the effect of the young stupid human on the doctors and nurses of an Emergency Department somewhere. There is always a patient much like this one who sucks the resources of the department dry while we try to care for other patients who didn't choose to do stupid stuff to themselves. Enjoy, and dig a little deeper in your pockets, you are paying for this guy's care.
*addendum: if the youtube credits are to be believed, the dirtball in the film is the person who put the video up on the net. this is either a well done fake or a real live dirtball who can afford a car (per the paramedic's history he was driving), killer tats, fine hood-ware, a computer, and some knock-down 'illy', but not medical insurance- the ER is free dude! :) *
Sunday, January 20, 2008
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At least you get to use restraints; if I tried to do that in the UK, I'd be in violation of his civil rights...
ReplyDeleteHow about a nice elephant tranquilizer?
ReplyDelete"AAAAAAAAAAAAAAAAH! BA BA BA BA BA BAP"
ReplyDeleteWhen a nurse/doctor gets beaten to death or made retarded by a violent patient, then maybe restraints will be legal in the UK...
ReplyDeleteThat is one fat doctor.
ReplyDeleteWhat is the problem; completely normal behavior.
ReplyDeletei just wrote a whole post about my two twelve hour shifts this past weekend, more a vent than anything else, but i stole this and added it to underscore my point!
ReplyDeleteyes, the doctor in question is fat. it's a challenge not to join him. no time off to eat, pizza and candy readily available, 10-12 hours on your feet. that guy's so fat he bleeds gravy.
ReplyDeleteI think that reporter used to be on MTV when I was in high school.
ReplyDeleteI can't imagine having to deal with people like this day after day and remaining pleasant to be around. I appreciate the fact that you do your job because I don't think I would be able to!
wow, they kept him there right at the hospital entrance for all to see. I pity the "normal" patients/families entering the hospital who had to witness this disturbing spectacle.
ReplyDeletedear ailan,
ReplyDeletei know it seems strange but that's really the best place for him. federal, it may be state law, has prohibited the presence of video cameras in patient rooms. therefore, while this guy would be best cared for in a closed room, with restraints, sedated, on a monitor, with a video camera on him as a backup, we are not allowed to do that. your second point about it being a 'distubring spectacle' is true, but it's simply what the ER has become everywhere i've ever worked.
I gotta hand it to the doc. He really kept his cool while being interviewed.
ReplyDeleteAs a matter of preference, I would NOT have used a phenothiazine to treat him (like Haldol). I would have used a butt load of benzos.
You never know about the QT interval, and this guy's not gonna let you close to him with cardiac monitor leads. One slip up with torsades or VT, and this guy's "loving family" will come crawling out of the faux wood paneling in their trailer.
In the old days, Droperidol was a great choice, Haldol is also an old standby, and of course there's the "new and improved drug": Geodon. But all of these have the QT prolongation issue. I've never seen it happen, but it's out there...and a lawyer would certainly find some cases and the FDA's helpful little black box.
You can't overdose someone in this condition on benzos. If they do stop breatihing....just tube 'em. (I refer to this as a Dr. Darwin consult).
As an aside, if I was really worried about my safety and the safety of the staff, my second preferred method of treatment for this dude would be 3 to 5 mg/kg of Sux IM with an IV, airway equipment, and Versed standing by.
I've had to do that 8 or 10 times in the last few years. I've been happy with the outcome each time.
What they left out of the video was the "foot-tappers" and "hand-wringers" in another part of the ER who demand to know how much longer they're gonna have to wait since their child with abdominal pain (who is afebrile and sitting up watching TV, and has Cheetoe dust around his mouth) is "very sick").
Anyway, on to the treatment debate. I'd vote benzos alone for this guy. What do y'all do?
As for the Anon with the "fat doctor". Come kiss my fat hairy ass!. Now I'll admit that that guy was pretty big, and I'm not nearly that large, but you try about 6 months of my schedule (where the only place open after 11pm is Whataburger) and see how easy it is to stay thin. I don't lecture patients about weight, so I'm not a hypocrite.
I'm not in the ED to be your clinical advisor/health nut...I'm there to save your life and it's what's between my ears that does that...not what's between my naval and my lumbar spine.
Pathetic example of undersedation. I don't care what drug is used, you can't just let him carry on like that. He's more likely to die or become injured from his agitated delirium than from any medication we might administer.
ReplyDeletePhysical sedation is only a bridge to appropriate chemical sedation. I'd start with the B52, then repeated Ativan every few minutes as needed. If we have some beefy guys to hold him down for a quick mainline, so much the better.
I put a surgical showercap over their face to prevent spitting too.
"Physical restraint" is only a bridge to chemical sedation, not an endpoint itself, I meant.
ReplyDeleteAgree with Scalpel. This guy needed to go nighty-night.
ReplyDeleteThen don't forget the Joint Commission requirements that you have to check on him every 15 minutes, ask if he needs to use the bathroom, provide him with a urinal while he tries to bite you in the neck, etc.
I laughed at the end of the clip where the reporter asked him something, he snapped at her, and she jumped.
Welcome to our world.
I agree with scalpel and white coat, he definatly needs some sedation! I saw a nut like that break through the leater restraints one time...
ReplyDeletethe treatment that this guy received was probably a bit tempered by the presence of a reporter with a video camera. i think they wanted her to get to the point of being scared before they B52'd him. boy do i miss inapsine!
ReplyDelete"What they left out of the video was the "foot-tappers" and "hand-wringers" in another part of the ER who demand to know how much longer they're gonna have to wait since their child with abdominal pain (who is afebrile and sitting up watching TV, and has Cheetoe dust around his mouth) is "very sick")."
ReplyDeleteAmen to that Doc!
This situation is not unique but typical, especially at the beginning of the month when the "checks" come out.
I've been kicked at, spit at and called almost every filthy vile name in the book. That's why I love ER....it gets me so hot!
911 is surely right. We'd never let a guy act like this for that long. It must have been the presence of the news crew. If I didn't put him down, I'd have every nurse in the department on my ass! Most would have the drugs taped to their scrubs already waiting for the order! I love ER nurses!
ReplyDeleteYeah. Before screamers even reach triage, one of us nurses is already yelling, "Who has the narc keys?" (yes, in our super new high tech ER we still lock up the narcotics etc in a freaking stupid cabinet).
ReplyDelete911
ReplyDeleteI still use inapsine and LOVE it. To hell with the black/green/or whatever the f**k the color of the box is. In this guy I prob. would have used geodon followed by benzos.
CAT
Oh, it surely is time for some Ativan...and not just for the patient.
ReplyDeleteWhy obscure his face? If you are stupid enough to do this to yourself, the rest of us have a right to know who you are.
ReplyDeleteYeah, yeah hippa et al but you surrender hippa rights for certain treatments (any controlled rx, for example) and presentation in this condition under arrest should be such a case.
I believe shame needs to be reintroduced as a social concept to foster self reliance and public behavior.
anonymous...
ReplyDeletebless you.