Blood, sutures and tongue

03/24/2009 at 8:24 PM 1 comment

Today was exciting in many ways. Besides having several interesting and challenging diagnosis to wrangle a young man came in with a fairly significant cut on his middle finger ( pointer). He was working with a machine and without warning it had gashed him. One of the PA’s at my office offered to suture it because I was running late.

A knock came to the door. “He is pumping blood”. I hurry over and indeed he had gashed a small arteriole in the distal finger. I had been barely contained until the lidocaine went in. I dont get many of these squirters so I dove right in. There are several challenges, one is that there is blood all over the field and it is hard to see. The other is getting the brain to ignore the blood. It feels like the patient is going to bleed out but the total amount of blood is tiny if you can focus on stopping it. ( grace under pressure). Then there is the technical challenge of actually stopping the bleeding.

On top of that we dont have the kind of instruments that the OR would have or the OR tech either. 

Nevertheless I have been doing this a long time and I allowed myself the luxury of enjoying the challenge. i miss the OR because of the intensity, the fact that the whole world dissolves away and you can focus on one particular thing. I managed to get a figure 8 stich which dropped the bleeding to a very minor and manageable oozing. Then a simple interrupted stich to finish the job and finally a more relaxed figure 8 to make sure it would not start up again.

My patient was really appreciative that I saved his finger, being the middle one and all it was his main form of expression. ( I did not ‘save’ his finger, that was his perception)

This was followed by a older lady that bit her tongue. It would not stop bleeding. I tried to get her to go home and keep some crushed Ice on it but she wanted it sewed up. Who am i to stand between what a patient wants? The fact that I had never sutured a tongue before seemed a bit irrelevant and peevish so I let it slide. It would just worry her.

She was great, she did not flinch, the numbing  medicine itself slowed the bleeding down significantly. two stiches and it was done.  My fist oral surgery!!

Finally a dehydrated Diabetic ( recalcitrant diabetic–type one). She wanted an IV , she knew it would help her feel better.  I agreed, the issue was getting the IV. I dont get alot of practice so it took me a second try, but then she just filled up with fluids and felt so much better. OF course I used the opportunity to throw a little guilt her way. She is not taking good enough care of herself and has been in and out of the hospital for her sugar ( and ketones). So I reminded her that her babies needed their mom. In some ways we treat diabetes so well that people forget it is deadly.

We had a young woman like her die in her home just a year ago. She too was not taking care of herself.

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Entry filed under: true story.

Just close the door She did what?

1 Comment Add your own

  • 1. Physician Assistant  |  03/26/2009 at 10:56 AM

    It was a nice figure 8 stitch. Next arteriole spurting is mine. I’ll leave the tongues to you.

    Reply

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