[Khairan]

It's almost 2:30 am and I have to be at work in less than four hours -- I just got back at 1:30 from a shift that went way too long. Part of the reason (though not by far the whole of it) that it went long was a lady I had to "see" today. She suddenly felt lightheaded at work, collapsed into her chair and fainted for several seconds, and wound up in our ER. She was getting a CT scan, but they never got past the "scout" films. They went to check in on her after the scouts and she was there on the table, unresponsive. The radiologist started chest compressions and called a code, and then we (the medicine service) took over. My resident was the first on the scene and he began running it. We kept going for half an hour, amidst confusion of whether or not she really had a pulse, trying to find her chart, why she was there, what had been going on, and what her labwork in the ER looked like.

We were compressing so long that we started having to trade off so that the person working the chest didn't tire out -- I was in there for a while, in and out a couple of times. My first time in I remember feeling her sternum sink beneath my fingers and hearing a loud "crack" -- the sort of noise that vibrates through your bones rather than one you hear with your ears. I kept going until I couldn't press anymore, and then I handed her off. I remember during one of my cycles that I was sweating, and I could feel my arms beginning to burn and myself breathing hard. I can still feel it in my arms now...

I remember at one point, maybe halfway into the code, opening up her eyes and checking her pupils -- they were wide, fixed, not reacting at all to the light I was shining directly into them with my penlight. I think by this point we all knew what was coming, but we kept going hoping she would surprise us and spring to life again under our hands.

The woman's husband had been to the ER with her. He was in a waiting room. We never really got her back. After half an hour of no blood pressure and questionable pulse, I'm not sure how much would have been left to get back anyway...

I remember also my resident, who had his fingers on her neck at the time, saying that he had a strong pulse. I was excited at the first tanigble, positive turn this code had taken. Only a couple of minutes later he said that it was gone again, and he decided to call it. We stopped everything, he asked several times -- "Is everyone okay with this? Does anyone object to stopping this now?" No one did.

The doctor who had admitted her went to speak to her husband. I can't imagine what a shock it must be to take your wife into the hospital for a fainting spell only to have her die, suddenly and with no warning. The closest I can come to finding a reason is that she had a massive aorta -- we never got the CT but the scout films showed us that. I think it must have torn, a classic dissection of the ascending aorta. Sudden death. The thing of it all is that if she had only held out a little longer, we would have known what the problem was and perhaps been on our way to correcting it -- but she died right there in the CT room. I wonder if she saw it coming, or if she just passed out and was unaware of everything we did in the last half hour of her life on that little table.


Inna lillahi wa inna ilaihi raajiun.

[IbnMardhiyah]

I didnt understand like half of your medical jargon but I get understand what the net result was ... inna lillahe wa inna ilayhi raji3oun

When its your time, its your time.

At the same time you guys were working on her, ther as probably another presence in the room, waiting to take back what Allaah gave her so many years ago.

[Khairan]

After two re-he-heALLy long days in a row (7:30am to 1:30am and 6:45 am to 11:00 pm) I've made a very important discovery today. A lot of the work I've been doing in the hospital for the past couple of days, mainly paperwork and dictations of patient history, can be done at home via remote access mechanisms. Awesome! I'm hoping that this really cuts down on my hours. I did some discharge paperwork today and two dictations while sitting at home on im, surfing the net, and with family guy in the background. It's much nicer than sitting in the hospital, I'll tell you what.

[Judicata]

Is anyone else scared by the prospect of being seen by doctors who don't get much sleep??

[IbnMardhiyah]

Originally Posted by Khairan

A lot of the work I've been doing in the hospital for the past couple of days, mainly paperwork and dictations of patient history, can be done at home via remote access mechanisms. Awesome!

Yeah, VPNs and telecommuting are cool, but they have their downsides.

[ChotooMotoo]

working from home is the best

[fatima]

awesome, my favorite thread is back

Originally Posted by Khairan

It's almost 2:30 am and I have to be at work in less than four hours -- I just got back at 1:30 from a shift that went way too long. Part of the reason (though not by far the whole of it) that it went long was a lady I had to "see" today. She suddenly felt lightheaded at work, collapsed into her chair and fainted for several seconds, and wound up in our ER. She was getting a CT scan, but they never got past the "scout" films. They went to check in on her after the scouts and she was there on the table, unresponsive. The radiologist started chest compressions and called a code, and then we (the medicine service) took over. My resident was the first on the scene and he began running it. We kept going for half an hour, amidst confusion of whether or not she really had a pulse, trying to find her chart, why she was there, what had been going on, and what her labwork in the ER looked like.

We were compressing so long that we started having to trade off so that the person working the chest didn't tire out -- I was in there for a while, in and out a couple of times. My first time in I remember feeling her sternum sink beneath my fingers and hearing a loud "crack" -- the sort of noise that vibrates through your bones rather than one you hear with your ears. I kept going until I couldn't press anymore, and then I handed her off. I remember during one of my cycles that I was sweating, and I could feel my arms beginning to burn and myself breathing hard. I can still feel it in my arms now...

I remember at one point, maybe halfway into the code, opening up her eyes and checking her pupils -- they were wide, fixed, not reacting at all to the light I was shining directly into them with my penlight. I think by this point we all knew what was coming, but we kept going hoping she would surprise us and spring to life again under our hands.

The woman's husband had been to the ER with her. He was in a waiting room. We never really got her back. After half an hour of no blood pressure and questionable pulse, I'm not sure how much would have been left to get back anyway...

I remember also my resident, who had his fingers on her neck at the time, saying that he had a strong pulse. I was excited at the first tanigble, positive turn this code had taken. Only a couple of minutes later he said that it was gone again, and he decided to call it. We stopped everything, he asked several times -- "Is everyone okay with this? Does anyone object to stopping this now?" No one did.

The doctor who had admitted her went to speak to her husband. I can't imagine what a shock it must be to take your wife into the hospital for a fainting spell only to have her die, suddenly and with no warning. The closest I can come to finding a reason is that she had a massive aorta -- we never got the CT but the scout films showed us that. I think it must have torn, a classic dissection of the ascending aorta. Sudden death. The thing of it all is that if she had only held out a little longer, we would have known what the problem was and perhaps been on our way to correcting it -- but she died right there in the CT room. I wonder if she saw it coming, or if she just passed out and was unaware of everything we did in the last half hour of her life on that little table.


Inna lillahi wa inna ilaihi raajiun.

inna lillahi wa inna ilayhi raji'oun. what are scout films exactly btw? ive never heard that term before.

[Khairan]

Originally Posted by fatima

what are scout films exactly btw? ive never heard that term before.

Scout films are quick scans they take to mark off the areas they are going to focus on during the CT. It helps the machine measure where to start the detailed scanning. For instance, if I wanted a patient to get a "CT chest," then this scan would not include detailed imaging of the neck or the abdomen -- the machine would "scout" the patient and measure where the chest begins and ends and then rescan the patient in a detailed way based on those measurements.

Here're some example of what a scout film would look like: