A Tale of Two ER Patients


The blood came gush from the nose

Staining the floor and the clothes

But a Merocel pack

Slid from front to the back

Brought a stop to the flood, I suppose.

 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. A month in the Arctic followed a month in Iowa followed 3 months in British Columbia, to which we have returned. Any identifiable patient information has been included with permission.

A tale of 2 ER patients.

I find the process of transferring patients out daunting and frustrating. The remoteness of the community demands stewardship of the two ambulances with their crews.  Thus, when possible, I send  patients to Prince George via POV (privately owned vehicle).

Even then, the process of stabilize-and-transfer can involve an hour or two of ER time when I get to chat with a patient.

I got to talk with a chef, who gave me permission to write a good deal more than I have. His camp, with 120 workers, employs three cooks, each responsible for one meal a day.  We had a great time talking about gravy; we agreed that corn starch beats flour for thickener, and that a good broth or stock means more to the sauce than the drippings.

*-*-*-

 

I gave a different ER patient the reverse of my usual dietary advice. Eat three scoops of premium ice cream at bed time, I told her.  Don’t drink water, always make sure your beverage has calories, especially high fructose corn sweetener.  I described how the Iowa beef industry uses it to accelerate fat gain in cattle.   I told her not to eat anything without gravy, mayo, or a sauce.

At the end, I said, “I write a blog. I won’t mention name, diagnosis, or age, but I’d like to write about the eating plan I gave you, the opposite of what I usually give out, how poison for one person is life-saving for another.”

She waved her hand and said, “You can use my name if you like.”

 

*-*-*-

During my IHS time in New Mexico, I saw 2 or 3 major nose bleeds a week for 18 months.  In that time, I became skilled at packing the front part of the nose to stop the bleeding.  Most times I could get the stanch the flow, and when I couldn’t, I knew what to do to get the patient to specialist care.

But since then the nose bleeds I’ve seen were simple, easy to stop temporarily followed immediately by a touch with a silver nitrate stick for permanent resolution. .

But the problem of serious epistaxis (bleeding from the nose) relies heavily on equipment, and the equipment has changed in the last 30 years. Our hospital has specialized catheters with inflatable balloons (the Rapid Rhino), and sponges made of material that promotes clotting (Merocel).  We also have tranexemic acid, unknown in the 20th century

For the time frame involved, I’ve seen more than my share of complicated nosebleeds this trip. I discovered that the closest Ears, Nose, Throat specialist doesn’t take call, and that most of the ER docs cheerfully confer by phone.

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