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The Stab Room September 5, 2013

Posted by therealtinlizzy in future physician.
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I mentioned in a post awhile back that I took up being a volunteer minion for a few shifts/month at HCMC in the emergency dep’t. Having been there over a year now, I was given the opportunity back in May to train as recorder/scribe for the stabilization room, to which of course I said yes please.

The stabilization room (referred to by staff as the “stab room”, pronounced stabe) is HCMC’s trauma/critical care area – a secured/closed off area of the emergency dep’t. I haven’t yet ascertained all of the minimum level of criticality factors that triggers a visit to the stab room. Certain circumstances are no-brainers for being stab cases:  a car crash victim, biker hit by a car, heart attack victim, patient found unresponsive, possible stroke victim, etc. However there are plenty of bloodied up, in-bad-straits folks who come into the ED via ambulance who don’t merit stab-room attention and are instead placed in one of the team center rooms (referred to as “cubes” by the staff, I suppose because the rooms are square-ish glass-doored rooms stacked one next to the other).

As an aside, anyone who’s ever been to a doc knows how klunky or unintelligible medical vernacular can be. Certainly medical lingo can serve a useful purpose when time is of the essence and strings of conditions, procedures and medication jargon can be whittled down to a more expeditious short-hand. To quote Danielle Ofri in What Doctors Feel on the language of medicine:

“A typical first line of hospital admission might read 82 WM w/PMH of CAD, CVA, MIx2, s/p 3V-CABG, c/o CP, SOB 2 wks PTA. BIBA s/p LOC. No F/C/N/V/D.”

I’ll spare you the verbose version of what that translates to, but suffice to say 309 chars shortened to 75 in the zippy pace of an emergency department can be a handy time saver for docs and staff across multiple patients over minutes, hours, days.

But I’ve also noticed some hospital vernacular that isn’t particularly shortened or efficient, it seems just needlessly not-how-real-humans-communicate. In HCMC, each of the separate care areas of the ED are referred to as “team centers.” As per above, obviously inside-baseball medical jargon is needful as a means for med professionals to communicate with one another. However, when it comes to the interface between medical-side folk and patients, it seems there would be some forethought to humanizing some details. Say, for example, when a name is chosen for a place where patients are cared for and where patients and families need to navigate to/from and all of the rooms & hallways look alike to those not familiar with the layout of the ED area. The designation “Team Center” might well refer to a collection of offices or conference rooms or a break area. I mean – one knows what those words mean, but nothing about “Team Center X” implies anything human-relatable in a healthcare or hospital setting. Might as well call them Sponch Zones (“Sponch” is the actual awesome name of a friend’s cat) or something equally meaningless.

Anyway, back to the stab-room. While the whole large room is an open-plan area, it’s partitioned into four areas, or “bays,” which can be curtained off from one another as needed. While each bay is equipped to treat most any cases that come in, each is geared slightly differently: one for trauma cases (accident victims, shootings, etc), one for medical cases (heart attacks, stroke, etc), one for pediatric cases, and the fourth for burn cases.

Most often there are med students on duty for any given shift who record as part of their learning/training, but when there aren’t any available or on duty, the red shirts like m’self get to record. And even if there’s a med student recording, I’m able to stay and simply observe the case.

Stab room recording entails scribing anything/everything medically relevant about a particular case from the time the patient comes through the stab room doors until they’re sent off for scans or to another dep’t (or declared deceased). When the EMS folks roll in with a patient, they rattle off all known info on the case or their encounter thereof, all of which has to be captured. This includes any/all of the following that is known (and there are times when much isn’t known): how the patient was found, who found them, all known circumstances of the incident/accident, meds or procedures administered by the EMTs, vitals, blood glucose levels, level of responsiveness, pupil reaction, etc. In the first minute or two the recorder needs to capture this flurry of info while the docs, nurses and HCAs get to work on the patient. From there on out, vitals (blood pressure, heart-rate, respiration rate, and oxygen level) are to be logged at least every 3 minutes, along with each occurrence of a procedure or admin of meds.

When there are no stab cases to record or observe (which is most of the time during any given shift), I just do the usual volunteer minion tasks and rounds. Incoming EMS interfaces with someone at the main desk in Team Center A to call in the impending arrival and a summons to the stab room occurs via overhead page, e.g.: “stab room personnel to the stab room, 6 minutes out, trauma.” This triggers all of the docs, nurses, PharmD and HCAs scattered among the 3 team centers designated as stab room staff to convene. Good on them for going with non-obfuscated verbiage for the pages. 😉

Arriving in the stab room I grab a clip board and paperwork and stand by for any further info EMS has sent ahead, find out from the stab room nurse (truly the Knower of All Things) and scribble down who’s the resident, attending doc, nurses (so many people, so many names to learn) for the case, along with any info already known.

On one particular occasion, all we knew about the case coming in was the type of trauma suffered, and that EMS was administering resuscitation attempts en route. There was a med student to record, so I just stood off out of the way to observe. When I observe, I take the opportunity to scribble notes on meds/procedures I don’t understand so I can look things up later (bless the internets). Sometimes there’s an opp to ask one of the med students or staff at the time, and sometime’s the time to just scribble notes to look up later (if I’m actually recording o’course I always ask).

Anyway, I watched the nurses unpack a bag of equipment I didn’t recognize, so I looked for any brand name or lettering that I could look up later. There was a flat but curved chunky sturdy piece of plastic that I guessed would go under a patient’s torso that had the letters “LUCAS” on it. Separate was a clunky mechanical device with curved “arms” and a plunger-like protrusion. What I soon observed was that the pieces together are a device which automatically administers chest compressions to a patient:

LUCAS resuscitation device

Within a few minutes the EMS came through the doors wheeling in the unresponsive patient, who at first glance appeared to be self-administering chest compressions with the EMS’s LUCAS device. The patient’s wrists were fastened to the sides of the device (to keep the torso/body geometry in optimum position for effective compressions? Or perhaps just to keep the arms of an unresponsive patient from just hanging about?) in a manner which moves the arms along with the compressing motion of the device, creating the queer illusion that the patient is self-administering the compressions. Having not known that such a device existed, and knowing that EMS was administering resuscitation efforts en route, I guess I had no reason to expect anything other than that one of the EMTs would be atop the patient still administering chest compressions when they wheeled the patient in. Makes me wonder how long those LUCASes have been in use in the field. Bet the internets would tell me that too.

Here’s a vid that provides a demo of the LUCAS, pretty cool actually:

I’ll keep it to those generalities on what sorts of cases I have the privilege of observing/recording in the stab room, being very cautious to stay on the correct/appropriate side of privacy and propriety. But suffice to say, it’s an order of magnitude more of a learning experience being in the stab room versus just the usual volunteer duties. It’s nice actually to be able to get to do both, as I do still enjoy being a regular red-shirt in the ED: stepping briefly into folks’ varying degrees of upset or just really-bad-day to contribute a smidge of not-suck, even if just for the moment or few I interact with them. But having the opportunity to see trauma care as it happens, and a practical context for learning terminology, procedures, methods, interactions, medications in a practical = really awesome.

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