Friday, September 02, 2005
Emergency Medicine: Days 3 and 4
Well, I missed posting yesterday - by the time I got off at 0500, I was really tired and I knew I would need to get to sleep pretty quickly, since I had to go to work today at 1700. Yes, that means I was off only 12 hours today. Not so bad, actually... I only slept about 5 hours and then was up again.
Last night (8/31-9/1/05) was pretty cool. I saw a bunch of patients and also had a couple of new procedures. I promise I'll explain these procedures and stuff someday soon. I was working with the same physician that I worked with the first 2 days - Dr. K. I really like working with him, except that he is psycho fast when seeing patients. He would see about 10 patients to my 1. It makes me feel really freaking inadequate and stupid; or maybe he is just really wicked-freaking fast, since it only takes me 10-15 minutes to see a patient as it is. I"ve been told he is just really wicked-fast. At the end of the night, he asked me if I was working with him again, and I told him I had two more shifts with him this month. He was very complimentary, which is awesome! At least it seems I am doing something right. So, the night was cool - I did 2 more LPs, an I&D, and sutured a simple lac on a patient's forehead. Not too bad; no central lines, chest tubes or reductions though. Hopefully, I'll get to do some of those before the month is over. I'm thinking of taking an extra shift on Labor day - I'm sure there will be plenty of trauma THAT night!
Procedure List (Day 3):
- I&D: 2
- Central Line: 1
- Simple Lac repair: 1
- Lumbar Puncture: 5
- Staple Application: 1
So, today I went in at 1700 and worked with another physician, Dr. R. I was a little nervous working with a new physician, but it turns out I needed not be worried. I was actually given more autonomy than I had with Dr. K; so, in a way, I had a better time, since I had some followup on my patients and I wasn't a complete procedure-bitch today. Not to say I didn't have some procedures, just not 5 hours worth :)
I saw a really freaking sick guy today. He was diagnosed with HIV 12 years ago and never really took any antiviral medications since then - he would go one week on or so and then take a couple of months off. His last viral load and CD4 count were about 1 year ago and he thought his counts were 150,000 and 101, respectively. Anyway, he came in yesterday evening with a fever, productive cough, and progressive dyspnea for the past two weeks. He also had extensive oropharyngeal thrush for the past 2 - 3 weeks, which has been progressing. Pretty sick fella. On exam, he was tachycardic with rales and rhonchi in bilateral lungs. He also had horrid thrush in his oropharynx and leukoplakia on his tongue. We worked him up: CBC, Chem7, blood and sputum cultures, and chest x-ray, and started him on some antibiotics. When everything came back, his CXR showed bilateral lower lobe infiltrates and peribronchial edema. His labs weren't overly impressive, but his neutrophil count was elevated, his lymphocyte count was depressed (not surprising, considering he has HIV). He was admitted to medicine for treatment. I feel kind of sorry for him - but then again, he did make the decision to forego treatment.
Today I did a complex repair of a guy's arm - he had an accident with a bush trimmer. Oops. So, I did a 3 layer closure - first I repaired the fascial covering of his extensor muscles, then a deep subcutaneous/dermal closure and finally a skin closure. Not too bad - it even looks like it will heal nicely. Not too bad for my first major lac repair.
What else did I do? I drained a dental abscess - possibly the most disgusting thing I've seen in awhile. Something about pus draining into someone's mouth... yummy! I also did an I&D on the leg - a "spider bite," which is only very infrequently actually a spider bite. Usually it is in fact a folliculitis - an infection in a hair follicle, that is often caused by S. aureus - a bacterium that normally grows on your skin and in your nose.
I'm really loving EM, as I suspected I would. Career decision confirmed.
Procedure List (as of Day 4):
- I&D: 4
- Central Line: 1
- Simple Lac repair: 1
- Complex Lac repair: 1
- Lumbar Puncture: 5
- Staple Application: 1 ¶ 1:18:00 AM
Last night (8/31-9/1/05) was pretty cool. I saw a bunch of patients and also had a couple of new procedures. I promise I'll explain these procedures and stuff someday soon. I was working with the same physician that I worked with the first 2 days - Dr. K. I really like working with him, except that he is psycho fast when seeing patients. He would see about 10 patients to my 1. It makes me feel really freaking inadequate and stupid; or maybe he is just really wicked-freaking fast, since it only takes me 10-15 minutes to see a patient as it is. I"ve been told he is just really wicked-fast. At the end of the night, he asked me if I was working with him again, and I told him I had two more shifts with him this month. He was very complimentary, which is awesome! At least it seems I am doing something right. So, the night was cool - I did 2 more LPs, an I&D, and sutured a simple lac on a patient's forehead. Not too bad; no central lines, chest tubes or reductions though. Hopefully, I'll get to do some of those before the month is over. I'm thinking of taking an extra shift on Labor day - I'm sure there will be plenty of trauma THAT night!
Procedure List (Day 3):
- I&D: 2
- Central Line: 1
- Simple Lac repair: 1
- Lumbar Puncture: 5
- Staple Application: 1
So, today I went in at 1700 and worked with another physician, Dr. R. I was a little nervous working with a new physician, but it turns out I needed not be worried. I was actually given more autonomy than I had with Dr. K; so, in a way, I had a better time, since I had some followup on my patients and I wasn't a complete procedure-bitch today. Not to say I didn't have some procedures, just not 5 hours worth :)
I saw a really freaking sick guy today. He was diagnosed with HIV 12 years ago and never really took any antiviral medications since then - he would go one week on or so and then take a couple of months off. His last viral load and CD4 count were about 1 year ago and he thought his counts were 150,000 and 101, respectively. Anyway, he came in yesterday evening with a fever, productive cough, and progressive dyspnea for the past two weeks. He also had extensive oropharyngeal thrush for the past 2 - 3 weeks, which has been progressing. Pretty sick fella. On exam, he was tachycardic with rales and rhonchi in bilateral lungs. He also had horrid thrush in his oropharynx and leukoplakia on his tongue. We worked him up: CBC, Chem7, blood and sputum cultures, and chest x-ray, and started him on some antibiotics. When everything came back, his CXR showed bilateral lower lobe infiltrates and peribronchial edema. His labs weren't overly impressive, but his neutrophil count was elevated, his lymphocyte count was depressed (not surprising, considering he has HIV). He was admitted to medicine for treatment. I feel kind of sorry for him - but then again, he did make the decision to forego treatment.
Today I did a complex repair of a guy's arm - he had an accident with a bush trimmer. Oops. So, I did a 3 layer closure - first I repaired the fascial covering of his extensor muscles, then a deep subcutaneous/dermal closure and finally a skin closure. Not too bad - it even looks like it will heal nicely. Not too bad for my first major lac repair.
What else did I do? I drained a dental abscess - possibly the most disgusting thing I've seen in awhile. Something about pus draining into someone's mouth... yummy! I also did an I&D on the leg - a "spider bite," which is only very infrequently actually a spider bite. Usually it is in fact a folliculitis - an infection in a hair follicle, that is often caused by S. aureus - a bacterium that normally grows on your skin and in your nose.
I'm really loving EM, as I suspected I would. Career decision confirmed.
Procedure List (as of Day 4):
- I&D: 4
- Central Line: 1
- Simple Lac repair: 1
- Complex Lac repair: 1
- Lumbar Puncture: 5
- Staple Application: 1 ¶ 1:18:00 AM
