I hate burns. Most things, I can deal with - but not these. Every time I've ever had to work even a smallish third-degree burn, I've had to go throw up. There's something viscerally icky about them. (On the other hand, I did not find the cockroach in the ear particularly distressing, despite the fact I also hate bugs and wish I could squish them all.) We have a burn unit in town, and I try to stay as far away from there as I can.
That said, Travis should have gone straight from the ED to the burn unit. We know County has one (Raul died there at the end of "The Healers"), so there's no particularly compelling reason why he should have stuck around in the emergency department. Burn patients infect very easily and require nearly constant monitoring, and we know that the ED is not the best place to either avoid infection or to be closely monitored. He should have been intubated nearly the moment he came in the door (burn victims have an obnoxious tendency to lose airways and stop breathing), aggressively worked up with fluids, provided with analgesia, and transfered. With burns, once the airway is taken care of, you're worried primarily about fluid loss from the plasma movement, so these patients need a lot of IV fluids. (Almost 2 litres per hour in this particular patient, as Carter noted.)
Lucy: Finally something I can applaud from this character who reminds me a hell of a lot of Falsone in season six of Homicide. The phone conversation between Travis and his parents was touching and perfectly done. Wonderfully considerate. I'm going to stop praising her now, lest it become a nasty habit.
Shannon's steroids: Once upon a time, a bunch of researchers did a study and came up with some semi-ambiguous findings that suggested that if you gave high doses of steroids to patients with spinal cord injuries, you could prevent or reduce some of the swelling and thus save a few dermatomes worth of sensation and motor function. Sounds great in theory. Unfortunately, these researchers made the fatal mistake of releasing their results to the media before they appeared in The Literature, and so it became a de facto standard of care: when "miracle treatment for spinal injuries" runs on the ten o'clock news, it's kind of hard to explain why you're not doing it. Several years worth of experience later, we can safely conclude that "high dose" really means "your entire hospital pharmacy stock," and even then, you might not get any result.
It's an amusing story to tell; Rich Wolfe debunked it quite thoroughly at last year's ICEM, and I really enjoyed his presentation on the subject. As for why people still do it, despite all the evidence to the contrary.. well, people are stupid, doctors included. I still know people who think you can actually definitively manage a hypertensive crisis. (The joke here is that within about two hours of discharge from the ED, most people in some kind of hypertensive crisis have the same blood pressure they did when they walked in the door.)
I've made all the comments I'm going to make about Ritalin and attention deficit disorder on Usenet; feel free to check the news archival services if you want to find the original articles. Brief, I don't think ADD is a useful diagnosis or even a real disease, and given what I said last week about the overuse of medication, I hopefully won't have to repeat my feelings about giving people drugs to take for the rest of their lives. (Lucy's what, 24? She's been taking this stuff since she was 11? That's basically half her life - it's essentially forever.)
Nit: I know it makes for good TV and/or entertainment, but it's dangerous to approach a helicopter with the rotors still turning; it's even more dangerous to try moving a patient under those circumstances. Wait for the thing to shut down, then go.
What the hell is it with Mark and milkshakes? The only therapeutic milkshakes I've ever had come from a place in Nanton, Alberta, and are useless for Bad Day Therapy in this context. My colleagues do a number of things - go running, tease cats, play video games; I either read C code or make elaborate Italian meals. You figure out which one is worse.
Scene I desperately wish had been in this episode:
Semi-personal note: a great TV show died this week - Homicide: Life on the Streets is apparently cancelled as of this season, so the episode airing on the 21st will be its last. Thanks for the memories, guys.