21 June 2016

Sweet Dreams and Armpits

by Melissa Yi, M.D.

A is for…


I'll start off with the second part of the title first.
When I get a trauma case, my priorities are ABC, or C-ABC

C-spine (some experts put this first, so we don't forget to immobilize the cervical spine)

Airway: is the patient talking? Bleeding? Suffering from a burn that will close off the airway?

Breathing: now check the lungs and chest. Look at the respiratory rate and oxygenation.

Circulation: is s/he bleeding anywhere? How are the blood pressure and heart rate?

D is for disability, which means a neurological exam. Pupils, reflexes, and strength if the patient will cooperate.

Dr. Scott Weingart, an emergency physician intensivist based in New York, emphasizes E for Exposure in penetrating trauma. You need to find the entry and exit points so the patient doesn’t bleed out from a bullet wound in the back while you’re messing around with a chest tube in the front.

So even before establishing airway, if the patient is maintaining an airway and has no blunt injuries, Dr. Weingart inspects “every square centimetre” of the patient’s skin, including the axillae, the back, the gluteal folds and the perineum, including lifting up the scrotum in a male patient. A much catchier mnemonic, proposed by Dr. Robert Orman, an emergency physician in Portland, Oregon, is: “armpits, back, butt cheeks and sack.”

With thanks to Leigh Lundin for pointing out that I had forgotten to post, and to the Medical Post for originally printing this clinical pearl.

Sweet Dreams

And now for a happy dance: one of my writing dreams has come true. When I looked at Rob Lopresti's column, I recognized the Forensics book cover by Val McDermid.

Why? Because it was chosen as one of CBC's best crime books of the season--along with my own Stockholm Syndrome.

Kris Rusch has said that you should make sure you set writing goals, which are within your control, as well as dreams, which are pies in the sky.

Well, I've been wanting to get on CBC's The Next Chapter for years. So I updated my list of writing dreams and goals here.

Goal: unlocked!

Of course, I have approximately 2 million other unrealized goals, but it's a start. How about you? What are your writing goals and dreams?

Signing out so I can get some sleep before my ER shift tomorrow. I hope I won't need to use my C-ABCDE mnemonic, but you never know what'll happen.

Peace.

5 comments:

Leigh Lundin said...

It’s good to have insight into such a discipline as emergency room intake. On television, we see barely living bodies arriving at ERs and we may write about them ourselves. At least we have a clue what’s right and what isn’t.

Congratulations on Stockholm Syndrome! Well done.

Anonymous said...

Dr. Orman might be Catholic. Even nuns giggled at the sign of the cross: "Spectacles, Testicles, Wallet, and Watch". Of course no one carries a pocket watch and maybe not a wallet or glasses. Congratulations on your novel.

Eve Fisher said...

Congratulations! Woo-hoo!
And love the mnemonic.

Melissa Yi said...

@Leigh, I knew you'd like it! Thanks.

Melissa Yi said...

@Anonymous, I'd heard of "Spectacles, Testicles, Wallet, and Watch" in a play, but had no idea it had anything to do with the cross. Neat! Thanks.

@Eve, woo hoo to you and all your cool writing too!