Is there a doctor in the house?

First off, you're probably thinking that I never intended on blogging EVER since I'm actually too busy with school and all that. BUT, you're all wrong, I'm just saving up awesome stuff to blog about. I'll bring them out as time goes on, it's mostly about patient confidentiality issues and all that stuff.

So, recently, I had my first experience of medicine in the public world. Emergency medicine, even. It has made me fall in love with the field even more.

Okay, onto the story. No names or identifying information is included for the protection of patient confidentiality. Yup, I uphold my HIPPA stuff.

Background: Earlier in the day, I was on call for my surgery clerkship. I got off around the afternoon after spending most of the day in surgery and lectures. Got dinner and all that and finally going out again for the evening. I spent the latter half of the evening at the ice skating rink with some newly made friends and meeting new people and having a grand time.

Incident: Near the end of the night, someone got injured and a couple of people that I met earlier that night pulled me aside and said, "Hey, you're the med student, right? Come help us out with this guy, he's cut up."

At the scene of the incident, there was a young teenager with a paper towel covered in some amounts of blood. While I was walking over, the history was related to me by an observer that the patient was cut by a ice skating blade and has been bleeding. I surveyed my environment and noted there was an open first aid kit on the bench, the patient, the patient's friend, and maybe a good 50 bystanders getting ready to leave for the evening.

Patient: Young teenager with several paper towels with some blood, in a lot of pain, vocalizing about his pain and covering his mouth. He appears otherwise in good health at first glance.

The patient's friend immediately told me that she is going to get the car around and asked me to do whatever it is that needs to be done and immediately left the scene. I examined the patient and asked him to let me take a look at the wound.

Wound: It appears to be an open incision made by a sharp object, it appears to be a 2 cm incision made through the upper lip at a 60 degree angle to the mouth from the midline towards the left just below the nose. The wound continues to bleed and the paper towel seems to be soaking up most of the bleeding.

I obtained additional history from the patient at this time. He had not yet washed out his wound and had only cut himself moments before I arrived on the scene. There were no immediate danger in the environment, I asked the patient to head over to the bathroom and wash his wound out as best he can. While the water may not be sterile saline that we wound normally use to wash out the wound, but irrigation of the wound seemed the best idea at this time to remove any contaminants that might have gotten into his cut.

While he went to wash out the wound, I looked through the first aid kit for anything to further disinfect the wound and prep him for the ER visit. I found a bottle of hydrogen peroxide, some povidone iodine wipes, alcohol hand sanitizer, and a small band-aid. The patient came back at this time drying his face with a fresh paper towel and avoiding the wound.

Tools of the trade:

Hydrogen peroxide - this is good to kill off a good amount of bacteria and viruses for surface wounds and cuts and it gets into the cut itself to kill off any Clostridium tetani (anaerobe that causes tetanus) that might get into a deep wound like this; this also causes a mild amount of damage to the tissues in open wounds and is quite effective at stopping capillary bleeding.

Povidone iodine wipes - this is the stuff that is used in scrubbing incision sites for surgical procedures as well as cleaning skin wounds; which is ideal for this situation as he has an open cut.

Alcohol hand sanitizer - this is obviously very important for the safety of the patient as I would not want to contaminate his wound with bacteria on my own hands.

Small band-aid - this is especially useful in this case to keep the incision closed, normally, this is done with steri-strips, stitches, skin glue, and various other techniques found in the hospital environment, but here, band-aid will do.

Having gathered all of my tools, I started my work. Patient was still in pain. I sprayed the incision with hydrogen peroxide, the patient yelped in agony for a bit. Sprayed it again, same effect. The wound was bubbling appropriately with the hydrogen peroxide. I then rubbed the wound's outer edges with povidone iodine wipes to clean off the edges and around it. And finally applied the band-aid, taking care to keep the wound together and prevent further contamination during transport.

During the time, the patient asked about scarring and what they would be doing in the ER to him. This wound would likely leave a scar if it doesn't close nicely, but given the straight incision and immediate care, the scar may be unnoticeable in weeks to months. And I advised him that they would likely stitch this wound up at the ER as it is fairly deep. I also gathered from him how he came to receive this incision. It seems that the patient had tried to remove his ice skate and had done so too aggressively and gotten too close to the edge, so to speak.

The patient's friend came back with the car and I sent them on their way to the ER and packed up the first aid kit and washed my hands.

Aftermath: The patient then spent 3 hours at the ER and got stitches for his incision. I later found this out from the friend at a later date.

So, that's how it went and I felt like a superhero and was treated pretty much like one for a lil' bit. It was exciting and fun and rather rewarding. I think I confirmed my calling in emergency medicine that night. Yup, this is what being a doctor will be like in the upcoming years, and I'm excited about it. =o)