3am Friday morning, I receive a page from the emergency room.
“I got a consult for you for a 19-year-old boy who just got shot in the foot, how quickly can you see him?”
“I will be there in 20 minutes”, I replied.
The patient had just gotten a late night snack with his friends at a nearby fast food restaurant. Little did he know that a simple drive could alter his way of his life forever. There was an accidental open fire on the vehicle that completely missed his upper body but went through his right foot while he was pushing on the gas pedal.
I arrived to the emergency department half asleep and half with high anxiety trying to imagine what the circumstances were. Was the patient in severe pain? Was he stable? Did he get shot in another place? Is there still a bullet in the foot?
I arrived to the emergency department half asleep and half with high anxiety trying to imagine what the circumstances were.
As soon as I arrived, I followed my algorithm for trauma. The patient was in slight pain, but he was breathing normally. The right foot had a wound indicating the bullet had entered from the top and exited from the bottom in an oblique angle. It was a clean hole that you could probe top to bottom. I quickly cleansed the area with normal saline using 9 liters. Thankfully, there was no severe contamination nor bleeding. I was able to calm the patient and prepare him for an early morning surgery to clean out the bones and soft tissue of his feet. His x-rays showed a shattered midfoot bone.
It was 5am as I prepared to bandage him and place a splint on the current patient. Suddenly, I hear another trauma code enter the emergency department. The patient was screaming in pain. I see a whole team rush to treat the patient with a lot of orders being yelled to help the patient.
It was 5am as I prepared to bandage him and place a splint on the current patient. Suddenly, I hear another trauma code enter the emergency department.
The ER doctor rushes to me and says, “Hey I got another patient here for you, it’s a crazy morning for podiatry today.”
“How bad is this next patient?“, I asked.
The doctor went on to explain, “I have an elderly homeless man who was sleeping on the side of the sidewalk. Both his feet were on the side of the curb where all of a sudden an 18 wheeler ran over both his feet. The truck jumped the curb since he had to do a wide turn. I guessed he didn’t see him; the trucker didn’t stop and he took off.”
I rushed to the new patient and my jaw dropped.
Both his feet had been severely crushed. There were a few bones sticking out from the bottom of his foot. There was a lot of blood loss coming from both feet. The patient’s feet were starting to swell rapidly out of proportion. My highest suspicion at the time was compartment syndrome.
I had to act fast, I checked each compartment of the foot for both feet. To my surprise, each compartment was elevated all the way to the calcaneus. This patient was going to need emergency surgery if he was going to have any chance to save both his limbs. I managed to stabilize this patient and prepped him for surgery.
Residency is definitely one of the most difficult and rewarding experiences in a young doctor’s career. You might be relaxed at home or sleeping one moment, and then preparing for two emergency surgeries the next. Your training will prepare you to handle any emergency so you can work fast to save a patient’s limb.
Residency is definitely one of the most difficult and rewarding experiences in a young doctor’s career.
Story by Dr. R.D.
All our authors names have been kept anonymous for this special edition. We hope you enjoy these great stories by podiatry residents.
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