Thursday, February 8, 2007

it's almost a full moon.

today was unreal. at least i know i can be a decent ER doctor - although i don't think i want the enormous responsibility of managing all of these horrible traumas/illnesses at one time. i'm just not good enough. is anyone??

today, i had the following cases present to me (all within 4 hours): 1) dog kicked in the head by a horse resulting in head trauma + broken jaw 2) different dog/same horse - kicked in the chest with horrible pulmonary contusions, hemothorax, rib fractures, and pneumothorax 3) different dog/same horse kicked in face - leaving large laceration that i had to sew up 4) dog that drank antifreeze an hour before and whose owners didn't have $$ for antidote 5) chocolate toxicity that ate 50mg/kg or some ridiculous dose AND THEN THE PIECE DE RESISTANCE: a DOG THAT WAS HIT BY A TRAIN. yes, you read that right - hit by a fucking train. his back leg was torn off at the knee, his tail was torn off, his head was degloved, and he had schiff-sherrington posture on presentation. 2 spinal fractures were found on xrays (after we bandaged him, placed an IV cath, and gave him his fluids and pain meds). the spine was actually broken completely in half and one fragment was underneath the other by about 6 inches. it was terrible. needless to say - euthanized. the owners saw the whole terrible thing unfold before them as they tried desperately to get him off the tracks.

i had to place a chest tube in the kicked dog (ALL BY MYSELF FOR THE FIRST TIME) and auto-transfuse all the blood right back into him, i cared for him all day, until he succumbed to internal thoracic bleeding - despite autotransfusion, packed RBCs, and heavy duty intensive care. thoracotomy/surgery wasn't really an option, so we tried to manage him (to no avail, obviously). i admitted him at 3:00pm, stabilized him, he crashed and burned at midnight. my antifreeze dog wound up being treated with PGA due to owner financial constraints and is currently doing well, my chocolate toxicity was stable and then suddenly (totally out of nowhere) FELL OVER FUCKING DEAD at around midnight too. no one has ANY clue why. he received the standard treatment for toxin - apomorphine, activated charcoal/sorbitol, IV fluid bolus. one moment, he was up and vocal, then he literally fell over and died. he couldn't be resuscitated. even the great sallye gregg is stumped as to why.

if i'd had 30 seconds to stop and think about what i had to do today - all the treatments i had to administer and the decisions i had to make, i think i would have been completely paralyzed by fear. luckily, i didn't stop to think. and i lived. not all of my patients did.

i was there 5 hours past the end of my shift at 8pm (it's 1:15am, and i just got home). i have to be back at work in 6.5 hours, so i think i should sleep now.

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