View Full Version : interesting occurance at the ER
NeoNeanderthal
06-26-14, 07:58
Was working at the ER this week and saw some cool stuff. A guy (mid 20's) came hobbling in bleeding from his right thigh a decent amount. I got all excited thinking it was a gunshot. Had a 5.11 operator belt wrapped around his upper thigh as a TQ (though it was sliding all around and was really doing nothing). He also had celox clotting agent in the puncture wound.
Long story short, he had a Benchmade asst opening knife in his right pocket. It opened as he was sitting and he sank it deep into his thigh. The triage nurse came out and took his belt off, pulled the celox out, threw a bandage on it and told him to wait with everyone else. Even though he insisted he was losing a lot of blood and may die, it wasn't an arterial bleed and wasnt bleeding all that badly. He was quite the bubba, saying to his girlfriend "I woulda sewn it up myself if we had needle and thread". He had the wound irrigated and he was sewn up and sent home.
Makes me understand the old-school fear of tq's seeing this donkey try to use one for non-arterial bleeding. Some people.
That's funny. Did you get his TOS username? :sarcastic:
At least the Celox was a smart thing to do, right?
ShortytheFirefighter
06-26-14, 09:23
It amazes me to no end how many people don't know the difference between arterial and non-arterial bleeding.
The best example of arterial bleeding I've seen so far was a guy who severed 3 fingers (and most of the 4th) with a table saw. It looked like the room had been shotgunned with blood. All over the walls, the ceiling, the floor, the saw...He was cool as a cucumber when we got there though, unlike the ones who aren't cut that badly and think they're knocking on Death's door.
thirteen/autumns
06-26-14, 12:03
At least the Celox was a smart thing to do, right?
From the reading of the OPs post it sounds like Celox was a little overkill for the type of LAC/bleed the pt was having.
Was this an otf type switchblade?
Yes, I know the OP said "asst opening knife", but I've wondered if an otf type would be a hazard with a surprise opening inflicting a heck of a wound...
Well, hopefully he realized that was a low cost crash course on why better tactical medicine classes should be in the near future.
Apricotshot
06-26-14, 12:54
Was this an otf type switchblade?
Yes, I know the OP said "asst opening knife", but I've wondered if an otf type would be a hazard with a surprise opening inflicting a heck of a wound...
No quality OTF knife I know of could be accidently fired while in your pocket. The switch is stronger than the pull weight on most revolvers. (Speaking of Microtechs (Not the Halo model) and Benchmade Infidel.)
My wife works nights in the ER.
I hear them all.
NeoNeanderthal
06-27-14, 08:25
it was a benchmade infidel and he said something about the lock being off and having his hand in his pocket. I have no clue how he managed to do it though. Maybe his girlfriend stabbed him and he made up the story. I'm sure the guy feels like a bad ass for self "treating" a self inflicted wound, but he woulda been fine with a towel and then some super glue later.
If I could stomach it, I'd go search TOS for the AAR on this combat medic, heroic story!!!
It seems my concern about otf knives, which a Benchmade Infidel is, is not that far off the mark.
If anyone's careless enough to put one in their pocket with the safety off...OUCH!
Off topic... but I've never understood the love of automatic knives. I mean... when I was a kid I like chinese stars and switchblades... but at some point, you just need a good folder... and to move on to an M4. ;)
Off topic... but I've never understood the love of automatic knives. I mean... when I was a kid I like chinese stars and switchblades... but at some point, you just need a good folder... and to move on to an M4. ;)
Because dude...it's called the Infidel! It's important that a mans knife identifies him as an astute student of culture.
Pussy. The fact he showed up in an ED at all shows his high-flow estrogen.
Hipaa stops me from sharing stories from the ER I work in...especially in any written form
Failure2Stop
06-28-14, 16:36
Interestingly, the other week I was present when a female cranked a round through her holster with a 9mm.
In and out puncture of upper thigh, long laceration of the outer calf, bullet impacted dirt.
By the time I laid her down and started to work down, a well meaning kid had already cut most of her pants off and applied a TQ to her thigh...between the puncture wounds. No arterial bleeding.
It is what it is, she's fine now, No harm, just over application of available items.
Hipaa stops me from sharing stories from the ER I work in...especially in any written form
HIPAA is vague and shady if your stories do not allow for any way to recognize or identify the patient. Now hospital policy may say otherwise. In any case, do tell....I worked an an urban ED for 10 years and I still love the stories....
Hot Holster
06-28-14, 17:32
My auto opener (without a safety lock), opened inadvertently in my pocket once, I rarely carry it anymore for that reason.
militarymoron
06-28-14, 18:58
non-autos can also open in pockets. i have an older strider-buck 880 (tarani) folder which opened partially in my pocket. the detent in the blade was too shallow; not deep enough to hold the blade securely in the closed position. i got a nice cut when i reached down inside my pocket to grab it, and my fingers ended up sandwiched between the cutting edge and the handle.
My auto opener (without a safety lock), opened inadvertently in my pocket once, I rarely carry it anymore for that reason.
Seems like a kydex knife holder or sleeve would be just the ticket if it wasn't an Infidel type that opened from the front. Does anyone know of such a creature?
The infidel I bought from a guy was also a play and **** around with victim also. He stabbed himself by inserting it against his leg and then seeing if it would penetrate.
Guy is a 75th Ranger member also.
HIPAA only applies if patient identification data is present.
My Infidel doesn't have a safety, nor do any of my other automatics. Anyway, I've kind of trended toward assisted openers over the last few years.
By the time I laid her down
A non-homo would have told us how big her titties were.
You need to come back to Utah this fall so I can talk to you.
Failure2Stop
06-29-14, 08:07
A non-homo would have told us how big her titties were.
You need to come back to Utah this fall so I can talk to you.
Hah!
You're right, looking forward to coming out again.
HIPAA only stops you from releasing information about the pt. The incident is all up for sharing though.
Best way to differentiate between an arterial bleed and vein bleeds, art bleeds are bright right, and squirt. Vein bleeds, dark and they ooze.
Had a guy a couple shifts ago hack into his L forearm with a chainsaw. Hunks of meat hanging out. This was an art bleed. However, our local protocol is slow to embrace changes, and has a tq listed as the last step of bleeding control, still using the pressure, elevate, cold packs, and pressure points before a TQ. I simply tq'd it, and put on a pressure dressing, sighting that the dressing wouldn't control the bleeding and a tq was needed. It's all in documentation.
Anyways, he bought himself a helicopter ride to a level 1 trauma center.
Most artery transsections will stop bleeding on their own. The artery retracts and circumferentially contracts due to the robust muscle layer that arteries have. No such layer in veins and they tend to be more troublesome, especially in a traumatic or guillotine amputation. A partial arterial transsection is often something to be feared, however. The remaining attachments can hold the artery open, preventing it from contracting. Direct pressure or tourniquet are good approaches if possible. In many ways, small calilber gunshot wounds to the extremities worry me more than large caliber. Not that long ago I saw a kid with a self-inflicted wound to the abdomen from a .22 pistol. It partially transsected his iliac artery. He lived, but it was a close call.
Years ago my bud would moonlight in an ER . I was able to hang out and observe the strange things. Night time was the most interesting.
Night time was the most interesting.
Always.
Gunshot wounds are always dramatic, but penetrating trauma is not that common in most ERs. Foreign bodies in the rectum, however....those stories are universal and never get old:).
Hot Holster
06-29-14, 13:13
I'm telling my age now, but years ago, before the major cities had an EMS system the police departments had station wagons set up with stretchers to convey the wounded to the hospital. I was assigned on one for several years and I transported a ton of people who were gunshot, stabbed, beaten, burned, or those with broken limbs, both victims and perp's. The ER's back then did not have the equipment they have now, and there were many times me and my partner had to hold our transports down on the table while the doctor probed the holes for bullets or the travel paths, hold gashes together while he prepped, keep them from jumping off the table as treatment was being done without pain killers. ER's are very interesting with the assortment of stuff that comes in and I have to tip my hat to those who work them.
Oh, and full moon nights are the worst.
Always.
Gunshot wounds are always dramatic, but penetrating trauma is not that common in most ERs. Foreign bodies in the rectum, however....those stories are universal and never get old:).
So true. Our local ER had an entire beer bottle recently. Bottom first....I saw the x-ray, then casually walked past the pt room. They didn't look too comfortable....
I'm not sure what part of the human brain says it'd be a good idea to shove a beer bottle up your ass...
So true. Our local ER had an entire beer bottle recently. Bottom first....I saw the x-ray, then casually walked past the pt room. They didn't look too comfortable....
I'm not sure what part of the human brain says it'd be a good idea to shove a beer bottle up your ass...
Beer bottles -- pretty good. Cucumbers and dildos seem to be the most common.
26873
The bottle is Texas Pete. For those unfamiliar with these x-rays, the other opaque hardware is from a previous spine fusion procedure.
Beer bottles -- pretty good. Cucumbers and dildos seem to be the most common.
Yeah, I guess the folks around here tired of the typical phallus like object. Probably have tried it one too many times and decided to really up the standards.
I once had a pt who had called a squad because of constipation for two weeks. This guy lived wayyy out in BFE, that makes our typical rural surroundings seem like a metropolis, and it was about 0030. This guys meets us at the edge of his drive, and is bent over, clutching his abdomen. He instantly goes for the back of the squad and hops in. So I go back, and he takes a seat on the cot. He tells me his situation and asked if he'd taken any laxatives. He said he did fifteen minutes ago and they weren't working. I told him that they would probably take a little bit longer to work since he had been bound up for so long.
He then tells me he grew impatient, and took a popsicle stick and inserted said stick into his rectum to try and dig out the feces. I did my best to not laugh. He then looked at me and stated that "You aren't a real man if you can't handle what I did to get it out." He also admitted that he got nothing out either.
I told him that I would never be a real man then, and took him to the hospital. I love my job...
I have to wonder though if he ended up getting a splinter and that's the reason he went to the hospital though. I can't be sure.
joshrunkle35
07-01-14, 13:31
Back to OTF knives...
I have two microtech ultratechs. If they make contact with something while opening, they come off the track and stop opening. They can immediately be popped back into place and go back to working as normal. If you open it directly over your leg, you'd get a small prick but the knife wouldn't go into your leg. (I've done it several times) Also, the release mechanism is usually too strong for most people to accidentally activate. My girlfriend cannot activate it when trying. Buy a microtech ;) (I am in no ways affiliated with their company, they just make really good knives)
Back to OTF knives...
I have two microtech ultratechs. If they make contact with something while opening, they come off the track and stop opening. They can immediately be popped back into place and go back to working as normal. If you open it directly over your leg, you'd get a small prick but the knife wouldn't go into your leg. (I've done it several times) Also, the release mechanism is usually too strong for most people to accidentally activate. My girlfriend cannot activate it when trying. Buy a microtech ;) (I am in no ways affiliated with their company, they just make really good knives)
I have difficultly deploying the DA Microtechs as well....
FYI: Don't try that with a HALO.
What a pussy. I was at the ER with Dad last week and observed an 83 year old dude come in with a towel around his hand, exposed it to the triage nurse and told her that he'd cut his thumb off with a table saw. He then told the nurse that he'd take a seat and wait his turn.
Old-guy tough...
Ned Christiansen
07-02-14, 13:18
I went to Spain in high school with some other kids and we all bought switchblades (one of my main reasons for wanting to go!).
When the time to leave neared, everybody started worrying about customs. There was nothing in the way of airport security to worry about in those days (yeah this was a few years ago!).
I wound up the lucky duck with three switchblades in each front pocket, both on the plane and going through customs. Got through OK but they kept opening up in my pocket and man did they have a really pointy blade shape!
These were tourist-grade knives and I doubt any of them made it a month before they went in the trash.
These were tourist-grade knives and I doubt any of them made it a month before they went in the trash.
Sounds like all the ones we used to bring back from Tijuana in my youth. They probably cost something like $10 at the time....and were worth, at best, $.10c
A non-homo would have told us how big her titties were.
You need to come back to Utah this fall so I can talk to you.
Meh. After a decade or so you stop caring, especially when the ones you migt actually enjoy are less than 10% of patients. Typically out flop a couple of dying-jellyfish-looking things...
Been an EMT since 96 &doctor since 09, and NEVER seen a rectal foreign body. I swear Im a white cloud.
Been an EMT since 96 &doctor since 09, and NEVER seen a rectal foreign body. I swear Im a white cloud.
I just sewed up a 3-day-old rectal perforation laparoscopically and did a diverting ileostomy this past weekend. "I fell on it in the bathroom, Doc. It was a one-in-a-million shot".
I just sewed up a 3-day-old rectal perforation laparoscopically and did a diverting ileostomy this past weekend. "I fell on it in the bathroom, Doc. It was a one-in-a-million shot".
In all fairness it COULD have been a one in a million shot. If you haven't read the book Shadow Warriors by Clancy and by some General I forget his name, some Rangers were cleaning up some of Noriega's men and did an explosive entrance on a door. The thug was hiding in the room, behind a chair in front of a massive fish tank. Blast took the door off the hinges and the door nob across the room and right up the bastard's rectum. The ranger's entered to find the guy flopping around on the floor with the door nob up his ass and fish flopping around on the floor.
In all fairness it COULD have been a one in a million shot.
LOL. You bet.
In all fairness it COULD have been a one in a million shot. If you haven't read the book Shadow Warriors by Clancy and by some General I forget his name, some Rangers were cleaning up some of Noriega's men and did an explosive entrance on a door. The thug was hiding in the room, behind a chair in front of a massive fish tank. Blast took the door off the hinges and the door nob across the room and right up the bastard's rectum. The ranger's entered to find the guy flopping around on the floor with the door nob up his ass and fish flopping around on the floor.
Was he planning on mooning the entry team?
Was he planning on mooning the entry team?
From my understanding, been a while since I read the book, he was cowering with his head down , ass up, and the trajectory was perfect. Could have been just in his skivies, but again been a while. Pick the book and up check and see, there were a number of rather amusing stories like that in it.
Rectal foreign bodies, narcotic prescription bottle lodged between a testicle and their fat thigh, fentanyl patches stuck in various body orifices, cervical spinal fusion scar dehiscence with a spinous process looking at me when I took the bandage off, baby hand sticking out on an office prenatal visit, penile wound from a drunk hooker that got carried away, orthopedic rod sticking out from a ankle with maggots crawling around from an open wound she had left like that at home for a mont .... Not much is surprising anymore....
Caduceus, that's amazing.
I must be a black ass cloud. I've seen a loooot of stuff up there.
It isn't the strangest, it isn't the most dangerous, it certainly isn't the biggest, but it never fails to make me chuckle and shake my head.
I saw a guy with an unbroken 150 watt lightbulb way up his cornhole.
What makes you think that would go smoothly? The OR is the best possible outcome in that little plan.
Makes me understand the old-school fear of tq's seeing this donkey try to use one for non-arterial bleeding. Some people.
Good thing he didn't come in with a head wound then. ;)
Caduceus, that's amazing.
I must be a black ass cloud. I've seen a loooot of stuff up there.
It isn't the strangest, it isn't the most dangerous, it certainly isn't the biggest, but it never fails to make me chuckle and shake my head.
I saw a guy with an unbroken 150 watt lightbulb way up his cornhole.
What makes you think that would go smoothly? The OR is the best possible outcome in that little plan.
were you the slightest bit tempted to just slap his cheeks real hard and lit him crap out the pieces?
A couple of weeks ago a guy went into V-fib arrest in front of me. It was one of those strange situations where the guy was semi-conscious while we did CPR. He would even say "Noo!!!" everytime we said "Clear!" to shock him. This went on for 10 minutes before I intubated him while he went in and out of V-fib. I've seen similar but less prolonged cases where people are kept conscious with CPR.
My all time favorite was the stripper who came to our ED because her "butthole looked weird." She was convinced that her boyfriend was doing something wrong since all of her stripper friends "take it in the ass and their buttholes don't look nearly as big." I shit you not. In all fairness, it was pretty gaping.
My all time favorite was the stripper who came to our ED because her "butthole looked weird." She was convinced that her boyfriend was doing something wrong since all of her stripper friends "take it in the ass and their buttholes don't look nearly as big." I shit you not. In all fairness, it was pretty gaping.
And the diagnosis / treatment was?
And the diagnosis / treatment was?
Taking waaaayyyy too much D up the A.
A couple of weeks ago a guy went into V-fib arrest in front of me. It was one of those strange situations where the guy was semi-conscious while we did CPR. He would even say "Noo!!!" everytime we said "Clear!" to shock him. This went on for 10 minutes before I intubated him while he went in and out of V-fib. I've seen similar but less prolonged cases where people are kept conscious with CPR.
I've seen similar situations in the cath lab with a patient becoming semi-conscious and reaching up when one of the larger/muscular techs was performing CPR. He'd pause briefly and the patient would drift back off. That's good CPR.
I've seen similar situations in the cath lab with a patient becoming semi-conscious and reaching up when one of the larger/muscular techs was performing CPR. He'd pause briefly and the patient would drift back off. That's good CPR.
I agree. I've never thumped that hard. I haven't seen anyone react like that even with the Lucas device.
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