A Night in the Trauma Bay

Last night (Wednesday) I got to the the ER around 8PM and left at 5:30AM Thursday. It was actually a pretty quiet night. In the 9.5 hours I was there, I only logged 8 patients, none of which was a true huge trauma. Earlier Wednesday morning a stabbing victim came in, but I was not there yet (DANG!). So! That's good for the city of Roanoke but makes for an uneventful night for us. Thank heavens one of my classmates was with me and my preceptor is very friendly, otherwise it would have been a long long evening.

There was one really interesting case though. They had Boerhaave Syndrome.

Basically what happens in Boerhaave Syndrome is there is an increase pressure in the esophagus from over eating, eating too quickly, or severe vomiting, which then causes your esophagus to rupture, and all the food or vomit that was in your esophagus is now in your chest cavity. As my professor says in his heavy southern-rural-Virginian accent: "This is B-A-D not good. That is some BADNESS." This is a problem, because you chest cavity is sterile and has now been contaminated. Treatment? Crack open the chest cavity, clean it out to get as sterile as possible, fix the tear in the esophagus, and put them back together. If untreated, there is almost a 100% mortality rate because you get a massive infection all around your heart and lungs.

So to put this in perspective for this patient, the poor thing was eating dinner, they all of a sudden got terrible chest pain and felt like they had aspirated a piece of meat (which means they felt like it had gone into their trachea or bronchi towards their lungs) and couldn't get it out. After seeing the CT scan, that piece of meat was floating around in their chest cavity. So what should have been a pleasant evening at home eating dinner turned into calling the cardiothoracic surgeon and having their chest wall broken open to retrieve that piece of meat. The ER doc on that night said the patient would most likely fully recover and be home in a week. How amazing is that!! Also, I might add this patient was in zero distress. They basically just sat there for a few hours with some oxygen in their nose waiting to go into surgery. Also amazing.

So! That was the most interesting thing I saw all night. One other thing I learned:

People having serious heart issues don't look like they do in TV shows. Granted we didn't get anyone having a full on heart attack, but we had a few people who could be well on their way to that shortly. While learning about MIs (myocardial infarctions...or heart attacks), I really imagined people in a large amount of distress, quickly crashing needing immediate life saving intervention. Sure, I bet those people exist, but the few people we saw last night who could have a full on MI at any moment were in absolutely ZERO distress, not too concerned, just casually talking, with their only complaint "My chest just hurts a little and my arm feels a little funny."

SO! As we are going out and about living out our lives, I think being educated on the signs and symptoms of a heart attack are important. What if you saw somebody in the grocery store having one? Would you be able to recognize it and know to call 911? The Cleveland Clinic has a great link about recognizing a heart attack I would recommend reading. http://my.clevelandclinic.org/heart/disorders/cad/mi_symptoms.aspx

To summarize, it was a pretty quiet night, but an exploding esophagus is pretty interesting at least!