medspeak - the ER dictionary

The Storm, Part II

Doing this as we go along in the episode (tapes are nice, huh?):

Kid with the suspected spinal fracture: if you sever the spinal cord in certain places, you can induce what's called spinal or neurologic shock -- arteries, which are made up of muscular tissue, lose the tension they normally have leading to a systemic loss of blood pressure, creating shock even in patients who have normal vascular volumes. I couldn't tell whether or not this had actually happened or not. He did, however, appear to have some kidney damage, so Benton ordered an intravenous pyelogram, where contrast media is injected and an x-ray taken to show lesions.
Girl with amputated wrist: what's wrong with giving these patients analgesia and/or some form of sedation? Do we like having patients screaming bloody (excuse the pun) murder and thrashing around while we're trying to work? I mean.. this isn't the Civil War.. we don't tell people to gnaw on a piece of wood. You give someone analgesia in cases like this. (Apologies to Steve Larson.)
Starring of the windshield in an MVA is never a good thing. Usually, it means that the head or some other body part hit the glass. As a general rule, anyone involved in an MVA with starring needs to go to the hospital; airbag deployments are other must-go indiciations, although a lot of people dispute this. (The funniest thing I've ever seen was an MVA happen right in front of me, at fairly slow speed, and the windshield just up and turned opaque. It took me a few seconds to figure out what just happened.)
Was the crane operator one of the cops that interrogated Harrison Ford in The Fugitive, or is it just my inability to distinguish between people who have that very cool Chicago accent?
Mark, I think the helmet was for you, not the patient. The best way, I've found, to protect patients while doing vehicle extrication maneuvers is, believe it or not, a spine board.
It kind of bothers me that there are no clearly demarcated patient areas in this emergency department. I can't really figure out where the waiting room ends and the treatment space begins; if you head down the hall off of chairs, you run into treatment rooms, right? I've complained about the security in the past at this hospital, so this isn't exactly a new comment.
Carter, you dumbass -- the first thing you do with a wet hypothermic patient is get rid of their clothes, otherwise all the rewarming efforts aren't work jack. (Cut them off gently.)
Hepatitis is a broad category of viral (and environmentally induced) conditions causing liver inflamation and cell necrosis. Symptoms of these diseases include nausea, vomiting, fatigue, and changes in taste, strangely enough. Right upper quadrant pain, jaundice, and other GI symptoms are also indicative of hepatitis.
Hep A is what used to be called infectious hepatitis -- it is a low mortality, short-incubation, mild form of the disease. It is primarily transmitted through the fecal-oral route, meaning people need to wash their hands more often. Primary at-risk populations include travelers, children in daycare, large institutionalized populations (eg, prisonners), and people who eat raw shellfish. Outbreaks of Hep A caused by exposure to contaimnated food or water are fairly common. You can be vaccinated against Hep A.
Hep B used to be known as serum hepatitis. It's a low mortality, long incubating, moderate disease, transmitted by sexual contact, needlestick, or exposure to contaimnated bodily fluids -- it's a lot like HIV in this sense. Vaccinations against Hep B are effective and widely available, although the usual course takes six months and a series of three injections before you're fully protected. (A "rapid protection schedule" is also available.) They're good for five years, so when Jeanie says, "I had one five or six years ago," it means she's got another one due shortly.
Hep C is a mild, low mortality form of hepatitis that has an uncertain and variable incubation period. It wasn't identified until around 1989 when a good test was finally developed for the disease; many people who have Hep C got it through blood transfusions before blood banks started screening donor units for Hep C in 1990. It is primarily spread by parenteral contact, although there's speculation that it can be spread through sexual contact as well.