Perfect Timing

Little OLD man brought in EMS, status post fall with bleeding scalp.

He was adorable. Pushing 90 and fretting over his beloved wife at home, the wife he cares for.

He had been working in his garage and tripped over something, went down and hit his head on his tool bench. Just Plavix and aspirin daily. I triage the patient, asymptomatic and talkative.

I carefully removed the EMS bandages and zip! A little arterial spurter shot a stream of blood towards the other side of the bed. Luck is my lady!

I covered his geyser and Dr S came in, one of my faves to work with, a no bull but thorough doc. He wants coags, lytes, and a CBC.

Dr S garbs up in a gown and mask and I set him up to suture, then I got to spiking a bag and starting an IV. I've got 4 other patients, managing my time here, doing my thing while staying close by to gofer for Dr S.

The little old patient chattered about his lovely wife and he kept looking down at his right AC where I was starting his line. I see a large maybe 1/2 cup gelatinous blood clot slither from behind his neck, down his shoulder over his gown. Gross.

Dr S asked the patient to stop looking down as it is messing up his view.

As pt looks down again, S gives me a raised eyebrow and a sweet smile, "do you have to do that *now*?"

I give him the eyebrow right back and redirect the patient, "IVs all done, now look straight ahead!" Patient apologizes, looks ahead and finishes his sentence, more about how he can't stay because he has to get home to care for his lovely wife.

I draw the labs, hook the fluids KVO and go to set the blood on my mayo table as Dr S finishes his last suture.

I look back at the patient as he goes from talkative to quiet, from pink to dreaded GRAY in a horizontal line moving down his face and body.

His pressure is cycling and pops up: 74/36, heart rate 42.

I lay him back and release fluids wide open as Dr S whips off his gown and mask.

I squeeze the fluids for a minute or two and the patient comes back around, gives a hoarse chuckle and says "I got kind of dizzy there."

I wink at Dr S "Aren't you glad we had that IV!"

He uses an index finger to shoot a glove in my direction.

The patient ended up spending the night, I arranged for a granddaughter to spend the night with grandma.