Friday, September 3, 2010

A TYPICAL DAY IN THE EMERGENCY ROOM

A TYPICAL DAY IN THE EMERGENCY ROOM


The Emergency room is a hectic but interesting and challenging place to work. It is characterized by various peculiarities, notable among which are:

THE SMELL

Various smells pervade the Emergency room depending on the time you arrive and what kind of emergency situation has just occurred, the notable smells are of blood, vomitus, urine and occasionally, air freshener.

THE NOISE


This could be from a patient in real or imagined pain, or from a relative who has lost a patient, it could also come from arguments between nurses and stubborn relatives who want to have their way e.g visiting hours.

THE REAL VS THE FAKE




There are patients who look very well but yet may be extremely ill. Others come in with complaints that cannot be termed an emergency e.g cough and cold and demand prompt attention as emergencies even above people that are critically ill,

BROUGHT IN DEAD 


This is a group of patients who are dead on arrival at the hospital, some have been dead long before being brought, others die on their way to the hospital.

THE JOYS AND THE SORROW


Sadly but true, there is a lot of pain and sorrow in the ER especially the helpless cases which are too far gone
to salvage.
On the flip side, there is a lot of joy when a patient is brought out of an emergent state and becomes healthy again.
On the whole, after working in the ER, one tends to appreciate one's little blessings.





image courtesy

WHEN YOUR FOOT SMELLS SO BAD DOCTORS WANT TO CUT IT OFF.




What's that smell? What's smelling?
In the Emergency room, when you get a smell so offensive that doctors scramble to put on their facemasks, nurses wish they weren't on duty and other patients temporarily forget their health problems and scramble away from the emergency room( if they can ); to the trained nose, the smell can only be from one source; a diabetic foot.

THE SCOURGE

A diabetic foot

occurs in a poorly managed diabetic who has a small wound on his foot, which the patient is either unaware of due to the reduced nerve sensitivity which complicates diabetes or poor wound healing. This leads to the patient hitting the wounded area unknowingly while carrying out his daily activities.
The wound, usually small, greatly increases in size and depth and may lead to the foot becoming gangrenous thus the horrible smell. A gangrenous foot more than likely will have to be amputated.

COMBATING THE SCOURGE

Diabetic foot management

1. Regular blood sugar monitoring especially in diabetics.
2. Diabetics should examine their feet regularly.
3. Diabetics should wear comfortable shoes and shouldn't walk barefoot.

(Dr Erhumu works in the emergency section of a busy African hospital.)


image courtesy

WHY YOU SHOULD TAKE THAT WOUND SERIOUSLY.



"STOP GRINNING AT ME"

The patient's face took up various contortions. His body was so stiff one would have been tempted to ask if he no longer possessed a flexible spine.

Probably if you had met him at one of the popular comedy shows you would have exclaimed, saying what a great comic he is.

He had a grin on his face, a scary grin.

This was no ordinary grin, this was the Devil's grin (Risus sardonicus).

WHAT IT IS

Risus Sardonicus is a characteristic feature of a patient with tetanus.

HOW IT OCCURS.

Tetanus

occurs when a wound is contaminated. The wound may be so small to have been overlooked by the individual. The characteristic grinning expression is caused by spasm of the muscles of the face. Spasms spread and may occur spontaneously or be induced by either sound or light, this may eventually affect the muscles for respiration and lead to death if severe and improperly managed.


PREVENTION

1. Immunization (ask your health care provider).
2. Wearing of shoes in sandy areas and general outdoors, also at risk occupations like farmers.
3. Proper management of wounds and wound dressing.

MANAGEMENT

Of an established case should be in the hospital.

(Dr Erhumu works in the emergency section of a busy African hospital.)



images courtesy
And

WHY YOU SHOULD MONITOR YOUR BLOOD SUGAR.

SUGAR COME, SUGAR GO!


Mama was wheeled into the Emergency Room by her anxious daughter and son-in-law. She was clearly unconscious and had been so for sometime. Questioning of her anxious relatives showed she had been on her way to the bathroom and was found on the floor unconscious.

Mama is a known diabetic and hypertensive, she had previously complained of hunger and had episodes of shaking before the event.
A simple test of mama's blood sugar on presentation showed it was quite low which could have accounted for her falling into coma. A diagnosis of hypoglycaemic coma was thus favoured.

WHAT IT IS


Hypoglycaemic coma

occurs when someone's blood sugar drops to dangerously low proportions. It is a medical emergency with a frightening outcome and very simple solution.

Normal blood sugar range is between 60-110mg/dl

Any value below that is at risk for hypoglycemia.

PEOPLE AT RISK

Though it could occur in normal people during periods of starvation, it usually occurs in diabetics when the dosage of their drugs is not properly regulated - this leads to a reduction in their blood sugar level to dangerously low proportions.
Ironically both low and high blood sugar levels are not desirable.

RECOGNIZING THE SYMPTOMS

In a diabetic this could include sweating, hunger and tremors.

SO WHAT BECAME OF MAMA?

A simple glucose infusion was given and in a few minutes, mama opened her eyes, began chatting and smiling and eventually got up and started walking.