Lakes aren't safe anymore either!

It was a tiring but very interesting weekend in the adult ED with the MUSC Program Director, Dr. Kini. I really like his teaching style. It's obvious he loves to teach students and that is what keeps him going at this point in his career. His 3-minute lectures are pretty classic and entertaining.

I believe I did a good job being thorough and efficient, his big concerns. So I hope he'll write a standardized letter of recommendation (SLOR) for me. I didn't get a chance to ask him at the end of my shift on Sunday because we had a couple very interesting cases come in.

First, a young mom got herself and her daughter into an accident. She couldn't remember how, but she drove her car into a tree resulting in a small transverse process fracture to her T-1 vertebrae (upper back) and pretty bad laceration on her lower lip. The EM resident wanted to repair it, but a Plastics Fellow finally showed up to do the job since it went all the way through to her mouth and had big cosmetic implications for a 20 year old. Everything went smoothly until we neared the end when we learned the next trauma case coming in was a 59 year old man that had his arm bitten off by an alligator! (Her daughter was fine, just a couple of scrapes and bruises.)

As you can imagine, there was a crowd waiting to see the guy arrive. I managed to get a good view since I working the ED and helping the young mom in an adjacent trauma bay. So the guy finally arrives conscious and in pretty good condition with the help of pain medication and tight bandages over the stump of his left shoulder. The EMS personnel told us that he was swimming in a local lake frequented by several of the ED staff. He was returning from a work-out when something tugged on his arm and presumably spun around to twist off his arm. He walked out of the water clutching his stump with his one arm. He was then airlifted to us while a large posse of active, retired and volunteer police officers went on a hunt for an alligator with a human arm in its mouth!


The alligator had to be killed and then cut open to retrieve the arm, which arrived on ice about a half hour after the patient. He was rushed up to surgery for an attempt to reattach his arm. Remarkably there wasn't much bleeding. Nurses that saw him walk out of the water probably saved his life by putting pressure and ice on the wound until EMS arrived. Even so, it was a pretty gruesome sight as the surgeon felt around for the brachial artery, clavicle and scapula/glenoid fossa. In typically clinical medical terminology, it was called a 'disarticulated' shoulder.

The story made front page news in town today. The article mentioned it was a 12 foot 550 pound alligator. I headed home a half hour later as he headed up to the OR for the attempt to reattach his arm. I kept thinking how weird it has been that I experienced shark and alligator bites on this rotation in little old Charleston.

Today Peds ER shift was pretty routine. I enjoyed working with the kids again though. Now it's time to finish my presentation for Dr. Upshaw on - treating shark bites of course!