Sunday, June 21, 2009

Elbow injury - "terrible triad" - the emergency room

This is part 1 of 4 posts I have written about my elbow surgery. You can read them all here:
Part 1: The Emergency Room 

Part 2: Surgery and Recovery
Part 3: The Ketamine Experience

Part 4: Follow Up

Three weeks ago I broke my arm/elbow. I thought I would document my experience so far.

How it happened 
I was on my road bike, with my feet clipped in. I was going up onto a curb and had to avoid a fire hydrant on the sidewalk. I was not really paying attention. My rear wheel did not make it onto the sidewalk and slid along the the curb a little bit until my bike abruptly stopped. At this point I tipped over with my feet still clipped in. I put my arm out to break my fall. My hand hit and I immediately felt my arm do something it should not do. I rolled over grabbing my arm and immediately yelled "Call 911" at my girlfriend, Kate, who was biking behind me.

Emergency Response 
The first couple minutes were not too bad. I laid on the pavement and kept my arm as steady as possible. It was across my stomach. My girlfriend called 911 and after some discussion about what town we were in an ambulance was on it's way. It turned out we were right on the border of Newton and Brookline. They directed the call to Brookline's 911 center and in about 5 minutes the Brookline emergency services showed up.

Everyone was very nice and asked me about 10 times if I had been wearing a helmet -- and I had been. After a couple minutes, they got a stretcher. I got up and walked to the stretcher with no problem. The ride to the hospital was uneventful. The driver and medic made corny jokes the whole way about how fast they were going and if I wanted to drive, etc. I think this is part of their spiel to keep the sick person awake, but I am not really sure. They got me to Brigham and Women's Hospital (by my and Kate's request) and got me right into the Emergency Room.

Emergency Room

In the emergency room they started an IV and gave me some pain killers. Up to this point I was only really in pain when my arm moved. After what seemed like a long time, I was taken to get x-ray images of my elbow. The x-ray process proved to be very painful because they needed me to move my arm around to get images from different angles. When the first image was taken, I heard the technician let out a gasp when he saw the picture come up. That is never a good sign. After 2 images were taken and I was in excruciating pain, I thought the technician said she needed to take one more image. I jokingly responded that I was beginning to hate her. She laughed, and said that actually we were all done for now.

I was wheeled back to my emergency room area. They examined the x-rays and determined that I had dislocated my elbow and that they were going to try to put it back in socket. They also warned me that sometimes these injuries are so bad that they require surgery. Yipes.

Conscious Sedation
They decided they would give me something called conscious sedation with a drug called propofol. Essentially, it would knock me out for only a couple minutes and they would put my arm back in its socket. Once they got the drugs from the pharmacy, they started the process. There were about 6 people in my room and they started giving me the drug. Every so often they would ask "Are you still with us?" and I would respond "yes". Eventually, they decided I wasn't going to go fully unconscious and tried to set my arm while I was still responding. They yanked on my arm and got it back into socket, or so they thought.

It turns out they had given me enough propofol to knock out a 200 pound person. They were very surprised that I was conscious through the whole thing. I believe I was actually the talk of the E.R. for a brief period. "Did you hear about the guy that talked through propofol?" I heard they even searched on Google to see if they could find something similar. They think it might have been because the blood pressure cuff was on the same arm that they were giving me the propofol. I remember the entire thing, which I guess is unusual.

Second Attempt
I went back for a second set of x-rays. When they lifted my arm to get an image, I (and the technician) felt my arm slip out of socket. They brought me back to my ER room and tried to put my elbow back in place again. It just wouldn't stay. They decided they would have to really yank on my arm to get it back in place and that I should be really knocked out for that. They decided on giving me Ketamine.

Third Attempt
The did a safety pause, which I thought was cool and then gave me the Ketamine and I was knocked out. I hallucinated and everything. (I will go into more detail on the Ketamine in another post.) It was very interesting, but not something I would want to do again. While I was knocked out, they put my arm back into socket. They also took CAT scans, which I vaguely remember.

So, my arm was back in socket, and my arm was in a split made of cast material. I also had a sling to hold my arm. The Ketamine eventually wore off, and I was given some pain meds. I slowly began to recover. Eventually, at 3AM we left the Emergency Room. They told me a doctor would look at my x-rays and CAT scans to see if I needed surgery.

 The next day a doctor told me I would need surgery to fix my elbow and scheduled surgery for Wednesday. I will go into detail on my surgery in a follow up post.

Of course, it was not a fun thing to go through, but I have to say that everyone involved was very professional and friendly through the whole process. The staff at Brigham and Women's Hospital were great and I really appreciate the work they did. The emergency response crew was also great.

This is part 1 of 4 posts I have written about my elbow surgery. 
You can read them all here:
Part 1: The Emergency Room 

Part 2: Surgery and Recovery
Part 3: The Ketamine Experience

Part 4: Follow Up

No comments: