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!

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