ALBINA, OR – An area resident covering the ED recently treated a patient with chief complaint of “depressed skull fracture,” by prescribing IV sertraline and paging the psychiatry resident. Brought in by paramedics late in the afternoon on Sunday, reportedly had a GCS of 8 and was vomiting profusely.
As the resident who was covering the emergency department was do so as a favor for a colleague who wanted to catch the Oscars red carpet pre-show, was himself coming off of a 36-hour rotation with behavioral medicine.
“The first thing I saw was ‘depressed’ and immediately locked into the acute depression pathway,” said Dr. Kevin Corbin, DO, repeating his first year of residency in the Northwest after transferring from a mis-match site in Kansas.
“EMS had already established IV access so I figure getting an anti-depressant load going was critical.” When his nurse questioned the sertraline order by noting that IV fluid was not in the Pyxis, Dr. Corbin advised to just call the pharmacy: “They can usually compound anything.”
Dr. Corbin was also keen to get the psychiatry resident in to consult. “They probably will wait until Monday to see him, but I thought I should get their input in case their exam recommends a medication for a slightly different neurotransmitter system.”
Feeling confident that with this patient he would showcase his skills in emergency medicine, Dr. Corbin also order q2hr serial Hamilton scores. “Page me if he trends up or down by more than 3 points so we can titrate the drip,” instructed Dr. Corbin, just before leaving the unit in time to catch the Farmers Insurance Guy win Best Supporting Actor.
