You’re driving home?

From the when-the-hell-did-I-get-old department.

We had a teenage patient at the patrol building the other day.  This post isn’t about him, it’s about his friends.  I asked how they would get home and they said they would drive.  Drive?! Are you fucking kidding me?  They looked like they were barely old enough to tie their own shoes, let alone drive.  I looked across the bed at a fellow patroller and she just gave me the knowing look.  You know that look – the one that a real adult gives you that means, “Grasshopper, now you know what we’ve been talking about all these years.  Welcome to old.”

On the plus side, the patient’s friends asked for permission before posting pictures of him on Facebook.  My generation is scared of information getting around on these social networking sites.  These kids have it right.

Watching Gray’s Anatomy considered … useful?

I knew that watching Gray’s anatomy would come in handy one day.  One episode of the show has a patient go into surgery due to some traumatic injury.  The surgeons keep mentioning a triad and that the patient won’t survive unless they keep the patient out of danger of this triad.  From what I can deduce, this is the trauma triad of death.

Besides having an incredibly scary name, the triad essentially says that there is a relationship between the coagulopathy of blood, metabolic acidosis, and hypothermia.  Being cold halts the coagulation cascade (meaning that blood won’t clot), which causes lactic acidosis.  The acidosis reduces heart function and thus the body gets even cooler. This triad of actions causes a downward spiral in the patient and thus leads to poor patient outcomes.

It’s incredibly important to keep your trauma patients warm.  Ski patrollers exist in a world where just about every patient is hypothermic.  Keeping the patients cool will only hinder blood coagulation and may lead to this trauma triad of death.  Now, should you be thinking about this triad when faced with a simple knee injury?  I don’t think so … but you should still keep your patients warm!