Thursday, August 30, 2007

Crack Kills?

I had my first official train wreck a few nights ago. Now when I said train wreck in my old unit, it was a patient that was sick as all get out, on all types of pressors, intubated and circling the drain with a thousand comorbidities and septic. Not here in the good ol' ER. I had an actual train wreck. Gentleman fell asleep on the tracks, was hit by the train and thrown approximately 40 feet into a concrete abuttment. Our good folks at ems gave us the heads up as they were bringing in other patients, medic 4 is working a pedestrian vs train. I slowly set up my trauma room, really not expecting to get this patient, I mean dude was hit by a train and thrown. After 30 minutes, I was about to go grab a bite to eat, really thinking that this was not going to make it to our hospital when the radio goes off. Giving us report. Ped vs train, vital signs stable, noticeable deformities to left arm and right femur, gcs of 14. I am floored. Not only am I getting this guy, but he is stable and talking!!! They bring him in and he does have two very nasty breaks, his r humurus is sticking out or the skin and the arm is at an awkward angle. The left leg is quite a bit shorter than the right with and obvious deformity to the femur. We intubate, so that we can adequately control his pain, and possibly reset some of his fractures. This guy has no other injuries. And, prior to intubation, he was totally with it and quite angry at the fact that we "ruined his buzz". BAT was 402. Positive for cocaine and thc. Now in my few months in the ER I have decided that crack, in fact, does not kill. It gives superhuman strength to people and allows them to survive the wildest traumas imaginable without a scrape on them. Roll your ATV off the edge of a 70ft cliff? No problem, if you are positive for benzoylecgonine (fancy word for cocaine, technically it is its metabolite, but whatever) you will have a 6 inch lac on the back of your head, no other head injury and no broken bones (and of course you were not wearing a helmet). Contrast this with the gentleman sitting at the red light that gets rear ended by a car whose brakes had failed, neither positive for any drugs or alcohol, crash speed estimated at around 35-40 mph, and the driver of the stationary car dies and the driver of the failed brakes car is a paraplegic. If we had thrown some crack into the equation, think, both of these lives could have been spared. I also am fairly sure that crack is also a highly potent fertility drug, but the verdict is still out on that, my er dr's aren't quite into proving my theory by ordering urine drug screens on all my pregnant patients for my sake of research=(.


ERnursey said...

Well all the crack 'ho's have 8 or 10 kids, usually all in foster care. Does that support your theory?

bohica said...

Yeah, that is kinda what I was going off of. All or our traumas that meet level criteria get a drug screen by policy, no matter how bad they are hurt (for the most part, level 2 are strictly mechanism with the potential for serious injury, so a whole lot of our level 2 traumas are discharged.) as are all of our psych evals. It seems like almost all of the women who test positive for cocaine have a ton of kids.