Hospitals are short on supplies and staff are working while sick, The New York Times reported. Brooklyn Hospital Center features as a microcosm of an overburdened state filled with coronavirus patients. The stresses of life in the ER are at an all-time high.
As shown in the Times article about the Brooklyn Hospital Center, hospitals in New York have been flooded with coronavirus patients—and they’re nearing a breaking point. “Licensed to treat 464 patients, the Brooklyn medical center typically has only enough staff and beds to handle 250 to 300,” the article said. “It is planning to increase that number by half if needed, but it may have to double it.”
The state of New York, especially New York City, has become the epicenter of the coronavirus outbreak in the United States. As of Sunday, New York had 60,000 of the nation’s 140,000 reported cases of COVID-19—over 40 percent of all American cases. With doctors working through their own illnesses and running short on supplies, the dread of having to one day choose between patients is looming. Life in the ER is never easy, but COVID-19 is making it worse.
The First Steps of Gunshot Trauma
An all-too-common scene playing out in the emergency department is an ambulance bringing in a victim suffering from a gunshot wound to the chest.
“The bullet may have struck the airway, or a major vessel, or the heart itself; and even if none of this has happened, there may be bleeding into the chest cavity or around the heart that prevents breathing and circulation,” said Dr. Roy Benaroch, Adjunct Assistant Professor of Pediatrics at the Emory University School of Medicine. “Your patient rolls in and he’s covered with blood. You see that he’s been intubated during transport; EMS is bagging him, breathing for him through the endotracheal (ET) tube in his airway, and he’s got two IVs already started.
“You stand aside for one of the more technically demanding moments—for EMS and your staff to move him from the stretcher onto your trauma room table, without dislodging his ET tube or IV lines.”
Then the real work begins. A doctor will check the patient’s ABCs first—airway, breathing, and circulation. In a matter of moments, the doctor will check to make sure the artificial airway is in place, then move on to listen to the patient’s breathing. If breathing is hindered by blood in the lungs, the staff will use a suction catheter in the ET tube, followed by chest tubes and a device called a cell saver, to clear the lungs and catch and recycle the blood, respectively.
All of that—and much more—comes before the patient is even moved to the operating room for surgery.
Difficult Diagnoses in the ER
Without immediate, life-threatening signs of trauma, it can be crucial to get a patient’s full story, especially when the cause of the symptoms is more difficult to determine. To better illustrate this, Dr. Benaroch offered a hypothetical situation: There is a female patient with dizziness, dry mouth, weakness, double vision, and other stroke-like symptoms. However, she didn’t actually have a stroke.
“The story is the diagnosis,” Dr. Benaroch said. “In almost all medical encounters, the story, the history of the illness, gives you the most important clues. We know a crucial lesson is to always pay attention to the history and the physical exam.”
Lab work can also speak volumes about what’s going on inside a patient when they can’t tell you themselves. “An MRI might be a good idea, too—that will get us a much better picture of her brain—but we don’t want to rush her off to that until we’re sure she’s stable,” he said.
After checking in on the patient again, he said, imagine that her weakness was getting worse.
“You think to yourself, always ABCs first,” Dr. Benaroch said. “If her muscles are getting weaker, is she going to have trouble keeping her airway open and is she going to have trouble with her muscles of respiration?”
The final piece of the puzzle falls into place when the patient’s husband takes a phone call and finds out that two friends that they saw this morning at a potluck meal are heading to the ICU with difficult breathing and vomiting. All three ate together.
“[The female patient] and, probably, her friends have a kind of food poisoning called botulism,” Dr. Benaroch said. “Botulism is caused by a toxin made by specific bacteria that can grow in contaminated food, especially food that isn’t stored or canned properly.”
If that sounds unlikely, he said, this case is actually modeled after a 2015 outbreak of botulism at a church potluck in Ohio, in which one person died and 28 were hospitalized.
Clinging to life by a thread, after multiple gunshot wounds, suffering reactions to potent toxic substances at an otherwise ordinary picnic—life in the emergency department is already chaotic at best. Staying at home to prevent the spread of the coronavirus isn’t just about those who choose to self-quarantine; it’s also about keeping the ER from suffering catastrophic patient overflow.
Dr. Roy Benaroch contributed to this article. Dr. Benaroch is Adjunct Assistant Professor of Pediatrics at the Emory University School of Medicine. He earned his B.S. in Engineering at Tulane University, followed by his M.D. at Emory University.