The Ortho Bomb Exploded

Yesterday was my weekend 24 hour call on the orthopedic service. And, it was a long one. In fact, the resident I was working with told me this morning that he had never had so many consults in one call. So much for my white cloud.

The day started of somewhat auspiciously. There had been 4 shootings during the prior overnight; mass trauma, and the E.D. was still feeling the effects. After rounding on my patients at 0630, "the Bomb" was passed off to the ortho resident I would be working with for the next 24 hours. I felt somewhat relieved. At least I wouldn't be getting annoying floor calls all day. However, the amount of consult calls we got all day more than made up for it....

"Humpty Dumpty" - we started off the day with the worst ortho case that would continue to haunt us for the rest of the call. A rollover, partial ejection. A young 24 year old that will most likely never walk again, and who will be lucky if they survive at all. They were driving and crashed their car. Most likely alcohol was involved even though it was still very early in the morning. A partial list of the injuries includes a spinal fracture that damaged their spinal cord, a broken jaw, a broken shoulder that will need to be replaced, broken ribs with underlying lung damage, abdominal injuries, a broken hip, a broken knee and a broken ankle. I went with him to the OR to watch the spinal surgery. After the opening of the case, I got paged back to the E.D. to take care of...

"Shot in the Butt" - another shooting victim who got shot... well, the name says it all. Unfortunately, the bullet went through the lower part of his hip bones, missing major blood vessels and nerves, and lodges just to the outside of his abdominal cavity. However, there was bleeding in the retroperitoneum (just outside and to the back of the abdominal cavity) so he was taken to surgery by the trauma service to explore the damage. After I finished with him, I grabbed something to eat and then was called back to the E.D. to help the Ortho resident splint...

"Motorcycle Man" - broke his wrist after dropping his motorcycle when he collided with another vehicle that didn't see him. He had a great attitude and joked through the pain of the splinting. His motorcycle friends were all decked out in their riding gear hanging out in the waiting area causing quite a sensation. We finished with him and had to run to the O.R. for..

"Humpty Dumpty" - their spinal surgery was finished and we had to rewrap their broken knee. Problem was that the fracture was constricting the blood vessel down to their foot, and it wasn't flowing properly causing problems. We splinted the leg as best we could to help with the blood flow and rushed the patient to the trauma ICU. As we were getting them settled in, we got another page to the E.D. for...

humerus fracture - woman hanging her potted plants outside and fell off her stepladder and ended up with a broken arm

wrist fracture dislocation - young man who was drinking and fell, dislocated his wrist and it had to be put back in place

bilateral wrist fractures - woman playing with her friend's children who fell backward and put her hands back to stop her fall, broke both her wrists

shoulder lac - man wrestling with a friend who cut his arm on a sharp object on the floor, Ortho was consulted because there was concern the cut went into his joint, it didn't...

cut wrist - former milk farmer changing a piece of glass on his barn. The top of the glass broke and fell slicing his wrist on the way down. He has nerve damage to his last two fingers and may need surgery. I sewed him up and sent him home. I will see if he comes to clinic this week.

revisit hardware wound check - patient with broken elbow wearing external fixation which is like a medival torture device. They were concerned that the wound wasn't healing properly and came into the E.D. to be checked out. I rewrapped her device and sent her on her way.

revisit hip pain - patient who was discharged home because he "felt better" who now returned with continued pain. I actually had seen him two days before when he was admitted. The circle of patient continuity continues.

This was close to midnight, and I think was having dinner around this time. I know I'm missing a consult or two because we were joking about having done a dozen by this time... well, you get the gist of the day so far...

clavicle fracture - I had just gone to the call room and had gotten settled when I got this call. Back to the E.D. for a patient who rolled over his ATV. I wrote the consult and went back to the call room as the patient was admitted and sent off for x-rays.

Three hours' later...

wrist fracture - young girl who fell down some stairs while intoxicated. We sedated her and put her wrist back in place. She was added to the growing list of surgeries for this next week.

ankle fracture - older gentleman who was drunk and fell breaking his ankle, it needed to be set and he was going to surgery when I left this morning since there were already a number of patients on the list due to all the consults we'd had during the day.

arm lac - guy fighting with guy gets cut with a box cutter. There was concern because there was muscle involved. Luckily, the damage did not appear to be significant and the patient was sewed up this morning.

finger lac - guy who fought previous guy and got his finger cut by a broken flying plate. He had a bleeder that I was having issues suturing, but I finally got it under control and spent the last hour of my call sewing his finger back together.

Whew! What a night. I was considering a lot of what happened. I was sad for the family of the young patient who is probably paraplegic. I know people who have children of that age. Children who often don't make the best decisions sometimes. The look of heartbreak on the mother's face haunted me throughout the day. I'll see how they're doing in the morning.

I was also realizing that this might be my last 24 hour call... ever? I have straight shifts pretty much from this time forward. I don't have another off-service rotation in my residency. Unless I decide to do a fellowship, I really won't be in a position to have to have another long shift... wow. Another milestone passed.

Now, I am off for some good sleep, in my own bed, that won't be interrupted by any pagers or phone calls. At least none expecting me to crawl out of my warm, cat covered bed to work with plaster casting materials...