Priorities

My last post mentioned priorities and how often, at least in our eyes as first responders, they can be quite skewed. Here's a good example:

We responded for a 55 year old male who was bleeding from a recent surgery site. When we arrived we were met outside by someone who told us the patient had undergone hernia surgery that same morning and must have popped a stitch getting in and out of the car when they went to run errands. We went inside and found that our patient was sitting in his kitchen typing on a laptop computer with no bleeding control measures in place at all. His jeans were saturated with blood from his waist to his knees.

 I wish I had taken the time to look at the screen to see what was so important that kept him sitting up, typing, and bleeding (maybe he was blogging about his experience). I asked him what was going on and the first thing he tells me is that he is feeling lightheaded and nauseous. Really? I can't imagine why. I told him to lay down immediately. His blood pressure laying down was 87 over 50.

I went to kneel down next to him and almost knelt right in a puddle of blood. I grabbed a nearby towel and laid it over the blood. His pants were undone and I lifted his shirt to see a completely clean surgical incision site. Weird. I told him I needed to remove his pants to examine the wound. He said okay but asked that I cover him with something, modesty I guess, but again - priorities, after all we were alone in his living room not in the mall. Turns out he was going commando but I barely had to move his pants down to see that the lower abdominal incision site was the one that was bleeding. I covered it with a trauma dressing and applied some pressure. I asked how long ago this happened and he said, "About an hour." An hour?!?! What have you been doing for the past hour? "Well, we just came back home from the store." A word of advice here, if you have surgery in the morning, don't go shopping in the afternoon. If you pop a stitch at the store and are soaking your jeans with blood, stay there and call an ambulance.

Next, I asked if he had any medical problems and he said he was diabetic. I asked if he took insulin or pills. He responded, "Oh god I take so many pills it's like a meal." Oh, okay, what for? "I'm HIV+." Oh. Now, I can understand not wanting to shout out to everyone who comes into your house your HIV status, but when you are covered in blood and the medical personnel ask if you have any medical problems, it might be the first one you mention. In fact, you might want to mention it in the very beginning. Of course we always wear gloves and take precautions against body fluid contact but it is still one of those things that makes you a little nervous and you like to know about as early as possible.

An I.V., some fluids, and an ambulance ride back to the hospital and this patient would be fine. I just really wish I knew what he was doing on that computer that was so important.