YOU ARE THE ER DOC!, Peter Meyer, MD, 2001
You are the ER Doc! presents true-to-life medical cases that might be seen in any emergency department in the United States. Patients are presented in short chapters, with questions and answers worked into each patient scenario. The reader is challenged to think, and, in the process, learn about medical care in general and emergency medicine in particular.
The cases are easily understood by the interested lay public.
The situations presented will help readers understand the how and why of patient care in the emergency department. Readers will gain useful and practical medical knowledge that they can apply to themselves and their, families.
The principles of medical practice presented in You are the ER Doc! would also be useful and interesting to persons with medical training such as medical students, nursing students, nurses, technicians, and even physicians.
This book is thought-provoking, entertaining, and educational. It is great for fans of the TV show, ER.
STORY FROM THE BOOK:
BB BOO-BOO
You are the emergency medicine doctor on duty in the Hometown Hospital Emergency Department.
Your patient is: Julie Camacho, 11 years-old.
"It was only a BB gun," Nurse Able says, "but she's complaining of pain in the abdomen."
"Let's go see her," you answer.
The girl lies on her side on the stretcher. Her mother hovers beside the stretcher, her attention riveted on her daughter. She pushes long, dark hair off her daughter's face, tucking it behind the girl's ear.
"What happened to you, Miss Julie?" you ask.
"I was playing outside on the dirt pile. Juan Valdez was there, too, with his BB gun. He pointed it at me, just playing, but I think he shot me. My stomach began to hurt."
"How is your breathing?"
"Fine."
"Show me where it hurts."
Julie turns over on her back and pulls the hospital gown up to her rib cage, exposing her flat abdomen.
"Right here," she says, pointing to a red circle the size of a BB, just below the bellybutton.
"I need to check your stomach," you say, slipping on a pair of exam gloves. You press on the girl's abdomen, every place but over the wound.
"Does it hurt when I press?"
"Not really."
Your gloved finger presses right on the wound.
"That hurts!"
The tip of your glove shows a tiny smear of blood.
Question 1 - You should:
A) Tell the police to put out an APB for Juan Valdez.
B) Put a magnet on the wound to suck out the BB.
C) Take X-rays.
D) Numb the wound and probe it with instruments to see if the BB is just under the skin.
E) Tell the mother to watch Julie at home and call you if her daughter vomits or has increasing pain.
Answer -
C) is correct.
"We need to take X-rays to see if a BB is inside you."
Julie bites her lower lip. "OK."
"Can my husband come back?" her mother asks.
"Sure."
Ten minutes later, you flip two X-rays onto the viewbox on the wall. You point with your index finger to a small, white circle in the center of one film.
"This is the BB," you say. "Metal shows up bright white on X-rays."
The girl and her mother nod. Julie's father, a short, stocky man with a mustache, peers intently at the films.
"The front view shows there is a BB inside you, but it doesn't show whether it's just under the skin or deep inside your body. The side view shows for certain - the BB is four inches inside your abdomen."
Question 2 - You should:
A) Prescribe antibiotics by mouth and let the girl go home.
B) Give intravenous antibiotics and watch the girl in the hospital.
C) Numb the skin and probe the abdomen to remove the BB while the girl is in the emergency department.
D) Order blood tests, a urinalysis, intravenous antibiotics, and call a surgeon.
Answer -
D) is correct.
"Your daughter needs an operation," you tell the parents.
"For a BB?" asks the father.
"A BB is a bullet, only smaller. It may have hit a blood vessel or put a hole in the stomach, intestine, liver, or spleen. We won't know until a surgeon looks inside."
Julie's father smashes his fist into the palm of his hand.
"I'll kill that Juan Valdez, I tell you. I'll kill the little punk."
"Hector," his wife says, "Control yourself. Juan Valdez is only 12 years-old. You'll not harm a hair on his body."
Question 3 - By law, you must:
A) Help the father find Juan Valdez and beat him up.
B) Find Juan Valdez and make him watch the surgery.
C) Tell the police to lock up the girl's father until Juan Valdez is in jail.
D) Take no action since Juan Valdez is a minor.
E) Report the BB-gun injury to the police.
Answer -
E) is correct.
In most states, an injury involving a firearm must be reported to the police.
One hour later, green scrubsuit-clad surgical technicians roll Julie into the operating room. After the surgery, the surgeon stops by the emergency department.
"Four holes in the small intestine," she says, shaking her head. "Could have been worse," she adds. "Could have hit the girl's aorta."
"People don't realize how dangerous BB guns are, do they?" you say.
"No, they don't."
"About 25 people in the United States die every year from BB gun injuries. Most of them are children."
"Such a tragedy," answers the surgeon.
"BB Boo-Boo" is reprinted with permission from Avian-Cetacean Press, Wilmington, NC.
ABOUT THE AUTHOR: Peter Meyer, MD, is a board-certified emergency medicine doctor. Through his writing, Dr. Meyer proves he is also an able teacher, an instructor with an ability to illustrate handling complex situations in a simple and straightforward manner.
SA 5 1/2" x 8 1/2", 160 pages, softcover, ISBN 0-9628186-2-3, BY6000 / $11.95