Archive for emergency department

fit data to your model [bobologie]

Posted in Kids, Running, Travel with tags , , , , , , , , , , , , on May 29, 2020 by xi'an

A few weeks ago, I contacted my general (and sport) practitioner for a mild issue with hurting toes, as they were indeed hurting and not only during or after my daily runs (!). Since the beginning of lockdown. I thought he would tell me to contact him later and stop running in the meanwhile but instead he told me to come to his office and after a rather cursory glance at said toes started discussing on a rare occurrence of COVID-19 induced frostbite-like toes. He then ordered a blood test which I took the next morn. Right after my (legit and solitary) one hour run. The results of the test were within the “normal” boundaries, except for the D-dimer test which was above the limit and is usually intended for detecting deep venous thrombosis. (As reported on Wikipedia, “a four-fold increase in the D-Dimer protein is a strong indicator of mortality in those suffering from COVID-19.”) This caused my physician to react quickly by prescribing me a cocktail of anticoagulants, corticosteroids and antibiotics. And another test four days later, incl. one for COVID-19. While anticoagulants made sense wrt to the coagulation issues, the corticosteroids were a surprise as they had been earlier pointed out as a potential aggravating cause for younger patients. Including by the French Ministry of Health. I thus asked my daughter for advice, as she had been triaging potential COVID-19 patients in the emergency room for the past month and she was strongly negative about the treatment, both because of the corticosteroids and of the antibiotics. Treatment that was apparently advocated by my practitioner on his own. I thus waited for the second round of blood tests, which returned a lower D-Dimer level and a negative signal for COVID-19. (In the meanwhile, I had spotted a BMJ paper on the possible impact of extended running on the D-Dimer levels and hence waited till the mid-afternoon to take the test!) While this ended up as a non-story, only made more exciting by the lack of competitive events during the lockdown!, I find it interesting that my doctor, who was most reasonably worried about the rising number of COVID-19 among his patients, leaned towards a viral conclusion with little data, as my month-old return to intensive (daily) running was a more likely explanation for sore toes…

an afternoon in emergency

Posted in Travel with tags , , , on September 2, 2015 by xi'an

Last Thursday, I drove a visiting friend from Australia to the emergency department of the nearby hospital in Paris as he exhibited symptoms of deep venous thrombosis following his 27 hour trip from down-under. It fortunately proved to be a false alert (which alas was not the case for other colleagues flying long distance in the recent past). And waiting for my friend gave me the opportunity to observe the whole afternoon of an emergency entry room (since my last visit to an emergency room was not that propitious for observation…)

First, the place was surprisingly quiet, both in terms of traffic and in the interactions between people. No one burst in screaming for help or collapsed before reaching the front desk! Maybe because this was an afternoon of a weekday rather than Saturday night, maybe because emergency services like firemen had their separate entry. Since this was the walk-in entry, the dozen or so people who visited the ward that afternoon walked in, waited in line and were fairly quickly seen by a nurse or a physician to decide on a course of action. Most of them did not come back to the entry room. While I saw a few others leave by taxi or with relatives. The most dramatic entry was a man leaning heavily on his wife, who seemed to have had a fall while playing polo (!) and who recovered rather fast (but not fast enough to argue with his wife about giving up polo!). Similarly, the interactions with the administrative desk were devoid of the usual tension when dealing with French bureaucrats, who often seem eager to invent new paperwork to delay action: the staff was invariably helpful, even with patients missing documents, and the only incident was with a taxi driver refusing to take an elderly patient home because of a missing certificate no other taxi seemed to require.

Second, and again this was surprising for me, I did not see many instances of people coming to the emergency department to bypass waiting or paying for a doctor, even though some were asked why they had not seen a doctor before (not much intimacy at the entry desk…). One old man with a missing leg spent some time in the room discussing with hospital social workers about where to spend the night but, as the homeless shelters around were all full, they ended up advising him to find a protected spot for the night, while agreeing to keep his bags for a day. It was raining rather heavily and the man was just out of cardiology so I found the advice a bit harsh. However, he was apparently a regular and I saw him later sitting in his wheelchair under an awning in a nearby street, begging from passer-bys.

The most exciting event of the afternoon (apart from the good news that there was no deep venous thrombosis, of course!) was the expulsion of a young woman who had arrived on a kick-scooter one hour earlier, not gone to the registration desk, and was repeatedly drinking coffees and eating snacks from the vending machine while exiting now and then to smoke a cigarette and while bothering with the phone chargers in the room. A security guard arrived and told her to leave, which she did, somewhat grudgingly. For the whole time, I could not fathom what was the point of her actions, but being the Jon Snow of emergency wards, what do I know?!

%d bloggers like this: