Good Luck, Ruth Johnson

Tip to Carter: do not live with people you work with unless you're romantically involved with them. It's just a bad idea. I don't know about John, but frankly, after a rotten day at work the last thing I'd want to see when I come home is my boss. (I suppose the same argument could be made for not dating co-workers.)

Lucy needs to learn something about treating kids -- don't use physical force, don't get the mother to hold them down, get the kids to trust you and they'll let you do just about anything. Jimmy looked to be about five, and there are ways to get kids that young to cooperate with the examination using the carrot, sparing the stick. I find it works better if you involve them in the treatment process, rather than make it seem like it's "you-vs-me." Doug has this routine down pat, so she ought to take a tip from him. (He's an attending, he has to teach.)

Wilson's trauma: You can see that this scene was shot in at least two parts (watch the chin on the cervical collar), and you can also see that the people who put this together don't know beans about sizing said collars. I've noticed this in past episodes, and it bugs the hell out of me -- the collar should be right at the chin, not way in front or way behind. My medical nitpick for the day, I suppose. They were concerned with internal bleeding, particularly a ruptured spleen (or at least that's what I got out of it; that's what I'd be worried about too with an MVA), fractured ribs, and spinal injuries. Ruling all of those out, he was then placed into observation partly out of policy and partly because the kid had no where to go.

In the past, I think I've mentioned the dismal survival rates for patients who arrest out of hospital following a traumatic injury; Andy is an excellent example of how seriously the odds are stacked against patients falling into this category. For starters, he's been down for 30 minutes upon arrival in the emergency department, and even if his arrest wasn't the result of a trauma, the odds are overwhelmingly against him -- patients down more than about 15 minutes prehospital generally do not survive.

I noted, back when Kerry was still passing her sternal saw study around, that thoracotomies should be reserved for those patients demonstrating some signs of life within five minutes of arrival in the ED; it's not clear whether Andy did or not (it's also never stated what his injuries are; trauma patients who arrest and die usually have tension pneumothorax, severe hypovolemia, or cardiac tamponade), but given the amount of time in this situation, I have to say I probably would not have opened the chest. (Then again, in a pediatric case, it's hard to say how I'd react and what I'd do, so I'm not second-guessing Kerry's decision to open.)

The Morbidity and Mortality conference was.. eh. Accurate enough up until the point that Corday went into her speech, at which point I went "forget it." Any hospital I've ever been in would have shut her down the moment the topic strayed from the case at hand. (She's right, for what it's worth, there is no compelling reason to make residents work 36 hour shifts and at a lot of places, they don't anymore. The reason most commonly cited is "I had to do it, they should too," which I don't find particularly satisfying. I do not think the policy of having extended shifts is in the best interests of patient care, but I don't set policy in that area, so what I think is sort of irrelevant. You can pass all the laws regulating shift hours you want, but it won't make a bit of difference because interns are used as cheap medical labour and nothing more. Sad but true.)

And please, don't even get me started on that delivery. Ugh. Ship them up to obstetrics, please, and spare us the cliches.

Ho ho ho. . .