January 30, 2014

Emergency medicine = sleep deprivation

Not a whole lot to update on right now. I have gotten to sew a few things up and have been complimented on my steady hand and sutures, so that's always nice. I was actually kind of nervous to do some suturing, as I hadn't done any since August, but I was obviously happy and eager to do it.

Nothing too exciting has really happened in the last week-ish. Couple STEMIs, broken bones, a-fib, drug-seekers. Saw a woman the other day with an H&H (hemoglobin/hematocrit) of like 6.8 and 20 something, so she obviously needed transfused. Saw a woman come in with abdominal/rectal pain, which her OB/GYN blew off as constipation and "the baby growing". The baby was growing, only inside her fallopian tube. It turns out she had an ectopic pregnancy and was bleeding into her abdomen. Um, I've seen a couple UTIs, a quadricep tendon rupture, and just a lot of nonspecific things like dizziness, headache, nausea, vomiting, weakness, etc.

On Monday and Tuesday I worked overnight. Wasn't too exciting, especially on Tuesday, which was a  very, very slow and long night. Overnights always mess my sleep up. I think I went like 30 hours without sleep, then got like 1-1/2hrs of sleep after my first overnight shift, then was up for another 15 hours for my second overnight shift. Then I went home and slept for like 8 hours straight and was up until like 4AM this morning before getting up at 7. And I always forget the day of the week, which screws me up even more.

Working again tonight from 4pm-12, and then tomorrow I think from 7am-3. Hoping to go home this weekend and see family before my last week in the ER and starting my surgery rotation the week after. I think I'll miss the emergency room, especially this one because I really like the people who work there, but I am very excited for surgery! Will obviously update again if anything exciting happens, but this may be my last ER post!

January 22, 2014

emergency med update #2

So far I am LOVING emergency medicine! There are still a lot of things I do not know how to manage, but I'm still learning!

I'm starting to get used to the structure and pace of the ER at Forbes. And I love working with my preceptor and seeing familiar faces around the department. I've met several PAs in multiple departments, including ED, trauma, and neuro, so far. It's cool to see how our field is branching out into specialties and how they are all working together. I would've loved the chance to rotate with trauma so maybe I'll get to do a little bit of that when I'm in my ortho surgery rotation.

I haven't seen too many "crazy" cases yet…Well, at least given my own definition of crazy. Last week we had a guy come in with a first time seizure, which ended up being from a large brain tumor. That same day we found out that a woman we had seen the previous day had a thoracic spinal mass that was compressing her spinal cord and causing numbness and weakness in her legs. I also saw a trauma case in which a guy was stabbed in the neck and chest. Apparently he had completely severed his jugular vein and had a tension pneumothorax. Needless to say he was rushed off to surgery. Today I witnessed my first death. A man came in with severe CHF (congestive heart failure) and he went into cardiac arrest and died after the techs spent 20 minutes trying to resuscitate him. I also witnessed a woman have a spontaneous abortion (miscarriage), and even was able to see the fetus/POC (products of conception) after they were expelled. It's a little surreal at times, seeing some of the things I see. It's like I almost remove myself from my body so that things don't phase me like they would other people. I don't know how to explain it.

Other cool things I've seen include subarachnoid hemorrhage, superior vena cava syndrome, crush injuries, incarcerated inguinal hernia, colovesicular fistula (imagine your colon being connected to your bladder and then trying to pee), hypertensive urgency, and appendicitis, among many other things.

So far I've seen a lot of sick patients that have to be admitted, so I'm hoping to switch over to fast track for a couple days and try to see some patients that I can "fix" in some respect. I'd like to sew some people up and drain abscesses. All that fun stuff. Some day next week or the week after I'm hoping to ride along with the EMS in the ambulance for a shift. I think it'd be fun and a good experience to see what is done to a patient before they arrive at the ED. 

That's pretty much all I can think to update about right now! This week I'm on 11AM-9PM tomorrow (in addition to Mon and today), Sat and Sun. Then next Mon and Tues I'm on from 9PM-7AM. I'm actually excited for the overnight shift because I know I really liked it while at Children's. So hopefully it goes well and I get to see some cool stuff. I'll be sure to update again when I get the chance!

January 14, 2014

Emergency Med

Can't say how excited I have been for this rotation! (and really nervous at the same time!) From my experience at Children's ED, I learned that I loved the busy-ness, chaos, pace of emergency medicine…the crazy hours, sleep deprivation, skipping meals, mixing up days of the week. I would not have originally imagined that I would like these things, and maybe I do complain about them some, but in the end, I love the thrill of the emergency department.

I started my rotation on Thursday. Arrived at 7AM only to find out my preceptor had told me the wrong day. So I played tag-along with other doc and then a PA-C. The structure of this ED is a bit different than that over at Children's. At CHP, I had a computer that I worked on. I used this station to sign up for patients, look through their history and triage, document, and discharge pts. Additionally, the docs used the computers to order labs/imaging, review results, order meds/fluids/etc. The computer told you where the patient was at, what was being done with them, what was coming up, and when diagnostics were ready. At Forbes, you triage on paper, document on paper, write orders on paper, review labs on paper. When you want to know what's being done with a pt or where they are, you ask. When you're ready to d/c a patient, you tell the nurse. Then the chart is dictated over phone to be typed up and entered into the pt's chart on the computer. But I'm slowly getting used to the system!

My first actual day with my preceptor was Sat, then I also worked Sun, and Mon from 4PM-12AM. A lot of geriatrics come in for various reasons. I have seen several falls, geriatric and adult, alike. One woman had fallen in a parking lot and sustained bilateral humeral neck fractures. Ouch. Then I've seen several older folks that had fallen and remained on the ground for several days, sustaining muscle injury, infection, fractures, and multiple abrasions. So far I've seen 2 STEMIs (heart attacks) and 1 stroke. Today I saw a case of appendicitis, a woman with a blood alcohol level of 490 (>80 is equivocal to a DUI), and a young girl that took 10 tabs of 325mg aspirin and 5 tabs of 550mg naproxen, among others.

Sun and Mon I was able to see pts on my own. After getting their histories and doing an exam, I then present to my preceptor and he may or may not ask what I think and what I want to do. Then we see the patient together, order labs, and review them when they're ready. My preceptor is very smart, and good humored. Really easy to get along with, as are the other docs and nurses. Compared to CHP, the ED at Forbes is much smaller and closer knit. One thing I do like is that there are not a lot of students, so I see more pts and have more opportunities to learn from the doc. There was a 4th yr med student there today, which as actually nice, so hopefully we'll get to work together a bit in the future.

I just got home from my shift a little after midnight and I'm still not exceptionally tired, which is why I'm writing this now. Working in the ED drastically messes with the body. Tomorrow (well today) I work 1-9PM, day off Wed, then 7AM-3PM shift on Thur and Fri. Almost tempted to ask the doc if I can work with the PA over the weekend, but we'll see! That's about all I have to say for now! Will post again with any exciting stories!