A day at emergency stations

As CCAD marks its first anniversary, the emergency department’s physician has opened his diary to show what challenges he faces on a given day.

Dr Brynn Karch is on constant alert while on a typical working shift in Cleveland Clinic Abu Dhabi’s emergency department – expecting to treat anything from minor injuries to critical cardiac arrests. As CCAD marks its first anniversary, the department’s physician has opened his diary to show what challenges he faces on a given day.

3pm: I've arrive at the hospital

3.15pm: It doesn't take long before I see a female patient with a severe pain in her flank (between the ribs and the hip). She is screaming and writhing in pain. I perform a physical.

4.15pm: As the laboratory tests are processed, I move on to a child with a history of asthma who has had trouble breathing. I listen to his lungs and can hear him wheezing strongly. Since the family doesn't speak English, I've requested a clinical interpreter.

4.30pm: While I wait, I request a vaporised breathing treatment to help relax his airways.

4.40pm: The interpreter arrives. I find the child has been having difficulty with asthma for most of his life but that this attack is worse than normal.

5.05pm: I check the results on my first patient. There is blood in her urine, meaning the issue is most likely a kidney stone.

6.05pm: I check back in on the child with asthma. Although still having trouble breathing, he is doing better. I ask the nurse to give another dose of treatment.

6.20pm: I speak with the parents again and learn he's been having a fever and cough. This changes things – I'm concerned pneumonia might be the cause of his breathing problems. I order a chest X-ray

6.35pm: My next patient is a male with lower back pain that he's had since a car accident five years ago. He was playing football when the pain increased. I look for symptoms that might indicate an acute neurological threat to his lumbar spine.

6.55pm: Thankfully, his examination is normal and I don't see cause for immediate concern.

7.20pm: My first patient has returned from her CT scan; she has a five millimetre obstructive kidney stone and signs of an infection – a urological emergency. I send her to the urologist.

7.50pm: We receive a 999 call – a patient is experiencing severe chest pain.

8pm: The ambulance arrives. The patient has high blood pressure, is sweating profusely, is having a hard time breathing and is clutching his chest – all classic signs of a heart attack.

8.05pm: I call a Code STEMI – a heart attack caused by a completely blocked blood vessel.

8.20pm: The patient is moved to the cardiac catheterisation laboratory, where we will attempt to unblock the blood vessel.

8.47pm: The catheterisation is a success; the patient survives.

8.50pm: My asthmatic patient's X-ray returns and it confirms pneumonia. As we don't offer paediatrics at the hospital, I call another hospital, which agrees to receive the patient.

9.30pm: I'm informed that an elderly man has been brought into the ED by his family because his speech is unusual and he's having trouble using his right arm; the nursing team suspect a stroke.

10pm: The CT scan confirms the patient is having an acute ischemic stroke – one of the blood vessels in his brain has been blocked by a clot. We order thrombolytic (clot-dissolving) treatment.

10.45pm: We receive a call from a small Abu Dhabi hospital with a patient who has been admitted with a hemorrhagic stroke – one of his brain's blood vessels has ruptured and is bleeding into the skull. They've requested our Critical Care Transport Unit take the patient to our Neurological Institute's neurosurgery department.

10.55pm: Another call comes in – we will be receiving a patient from the helipad in a few minutes. The patient has symptoms of progressive pain in his abdomen, which has been going on for two days.

11.20pm: The ultrasound shows the patient has a ruptured appendix. The surgeon rushes the patient to surgery.

11.45pm: A Code Blue is called in the clinic for a female who passed out while getting an injection. We find the patient pale, sweating and breathing heavily.

11.55pm: After examining the patient and seeing she was stable, we move her to the ED and perform laboratory tests, insert an IV, order an EKG.

12.25am: The laboratory results come back normal, so I send the patient home.

12.30am: My shift is over. Never a dull day in the ED.