Thursday, October 27, 2011
IM2: lame
Oh back to IM. I miss my cool residents and rockin team from last time. This one is a bit less... stimulating. The attending this week is brand new outta her residency and feeling overwhelmed with her normal patient load. So we see 1 patient each (1 other girl with me) and then we go home. And its not like it was with the other team where 1 patient is enough, she just wants the quick and dirty why they here, what's new and then says that's enough. She has spent a little more time forcing me to write better notes, but that's about it then we go home. That's like 7-10 (RIDICULOUS!). But Since I am studying for the USMLE Step 1 I guess its good. Now if only i could quit procrastinating....
Saturday, October 22, 2011
Peds ER: Ambulance ride-along
Even tho my rotation is technically over, I am required to do 1 ambulance ride-along. Its a 12 hour shift and I got to go hang out at the firehouse. Apparently, the firefighters and the paramedics are the same people! I totally didn't know that. The different alarm sounds tell them what truck to drive and what gear to put on.
I had a really good time. They go to the grocery store to buy meals, they have a nice kitchen, a huge TV, a study table, and bunk beds. Its actually a pretty sweet setup. I was sad in a way that I hadn't considered being a paramedic instead of medical school. You get all of the fun but less of the responsibility. The paramedics laughed when i told them this. I guess I deserved it since about 80% of the calls are not emergencies (free ride to the hospital).
After this whole experience, I think the paramedics opinions about patients are under appreciated simply because they get to take in the patient's home and surroundings. It really can tell you more about the problem than anything else.
Overall, it was a 'slow day' they called it. Only 4 calls and several calls that were cancelled on-route. The rest of the day I spent getting to know the paramedics around me, why they had chosen what they had and trying to glean any helpful information I could.
I did learn that usually on a 911 call here, there are first responders who appear on scene first. Then if further assistance is required or if the original 911 caller explains the situation well enough, then the paramedics are paged. I don't know who or where the first responders come from, but they were at all our scenes.
The paramedics I worked with were eager to teach me and more than happy to have me ride along. Things I learned were more about myself than medicine I have to say. The paramedics treated me like a doctor. They asked my opinions on things, forced me to do IVs and a few random other procedures. Many of the more serious calls have more than one paramedic team present. There is a call for a known diabetic in hypoglycemia (he is very agitated). So when we run in there is no time for introductions, everyone is running about. He is being held down on his bed, his has no pants or underwear, and he doesn't know where he is. The oldest paramedic in the room, maybe 40 comes up to me and hands me an EKG. He explains what he sees and asks if I agree. Then another paramedic who cannot get the IV in his hardened veins (on 8th try), says let the doctor do it. Then they hand me a bunch of needles (i have never done an IV before, much less a hard stick) and I try and try until I say, "its not happening." And they agree and hand me a needle and some glucagon. I try to explain I've never done it, but they keep insisting and saying things like "move for the doctor" and I try to stab the guy with the needle but I don't push hard enough. The needle bounces off and I have to do it again. Now this might not sound that exciting to some of you, but this is the first time people who have more experience than me are looking at me for answers. It was my first terrifying experience into the world of authority I suppose. I wasn't able to clarify I was just a student until later. And I can't help but have some doubts about my capabilities. Granted I'm only a third year, but it still makes me a bit nervous.
Other calls we got to go on were about a choking child, chest pain at a doctor's office, and a car crash that the helicopter had already arrived at and took the one critical patient. The picture is below of the helicopter as it took off...
I had a really good time. They go to the grocery store to buy meals, they have a nice kitchen, a huge TV, a study table, and bunk beds. Its actually a pretty sweet setup. I was sad in a way that I hadn't considered being a paramedic instead of medical school. You get all of the fun but less of the responsibility. The paramedics laughed when i told them this. I guess I deserved it since about 80% of the calls are not emergencies (free ride to the hospital).
After this whole experience, I think the paramedics opinions about patients are under appreciated simply because they get to take in the patient's home and surroundings. It really can tell you more about the problem than anything else.
Overall, it was a 'slow day' they called it. Only 4 calls and several calls that were cancelled on-route. The rest of the day I spent getting to know the paramedics around me, why they had chosen what they had and trying to glean any helpful information I could.
I did learn that usually on a 911 call here, there are first responders who appear on scene first. Then if further assistance is required or if the original 911 caller explains the situation well enough, then the paramedics are paged. I don't know who or where the first responders come from, but they were at all our scenes.
The paramedics I worked with were eager to teach me and more than happy to have me ride along. Things I learned were more about myself than medicine I have to say. The paramedics treated me like a doctor. They asked my opinions on things, forced me to do IVs and a few random other procedures. Many of the more serious calls have more than one paramedic team present. There is a call for a known diabetic in hypoglycemia (he is very agitated). So when we run in there is no time for introductions, everyone is running about. He is being held down on his bed, his has no pants or underwear, and he doesn't know where he is. The oldest paramedic in the room, maybe 40 comes up to me and hands me an EKG. He explains what he sees and asks if I agree. Then another paramedic who cannot get the IV in his hardened veins (on 8th try), says let the doctor do it. Then they hand me a bunch of needles (i have never done an IV before, much less a hard stick) and I try and try until I say, "its not happening." And they agree and hand me a needle and some glucagon. I try to explain I've never done it, but they keep insisting and saying things like "move for the doctor" and I try to stab the guy with the needle but I don't push hard enough. The needle bounces off and I have to do it again. Now this might not sound that exciting to some of you, but this is the first time people who have more experience than me are looking at me for answers. It was my first terrifying experience into the world of authority I suppose. I wasn't able to clarify I was just a student until later. And I can't help but have some doubts about my capabilities. Granted I'm only a third year, but it still makes me a bit nervous.
Other calls we got to go on were about a choking child, chest pain at a doctor's office, and a car crash that the helicopter had already arrived at and took the one critical patient. The picture is below of the helicopter as it took off...
Overall, a fun, educational experience. I hope to go on more ride alongs.
Friday, October 21, 2011
Peds ER: end of the story
So despite some disappointing turns in the middle of this rotation, it ended on a good note. I did feel like I finally had at least a small handle on what was going on, I felt well-liked and that I fit in, and of course that is the time that we end and move on. Seems to be a theme with these rotations.
So I did have some some amazing pictures of torn achilles tendons and whatnot, but unfortunately my phone screen fizzled out and i have no way to recover any of those pictures. So bummer on the fun stories, but yay I got an iphone so more pics soon. The cool factor in the ER stories seems to be related to how this injury happened and what it looks like rather than words on a page that would be fun to hear. So without pictures less cool.
I do still think I like ER the best tho. I just get along with everyone, you get to go home and have a life. The big issue is do I have the board scores. ER is becoming more competitive because it is so perfect a job. So I decided to sign up to take USMLE step 1 on Nov 22. That means that I have to spend more time in this next rotation studying for USMLE rather than a shelf or the rotation itself. *sigh* i don't want to study for boards again....
EDIT: So I got the resident to send me the picture of the achilles tendon rupture. Its the heel on the right, if the bruise doesn't tip you off, look closely at how the heels are lying. Also notice the tendon 'bump' on the left foot (you an feel it on your own foot) and note how the right is flat. + Homan's sign! BOO YEAH!!
So I did have some some amazing pictures of torn achilles tendons and whatnot, but unfortunately my phone screen fizzled out and i have no way to recover any of those pictures. So bummer on the fun stories, but yay I got an iphone so more pics soon. The cool factor in the ER stories seems to be related to how this injury happened and what it looks like rather than words on a page that would be fun to hear. So without pictures less cool.
I do still think I like ER the best tho. I just get along with everyone, you get to go home and have a life. The big issue is do I have the board scores. ER is becoming more competitive because it is so perfect a job. So I decided to sign up to take USMLE step 1 on Nov 22. That means that I have to spend more time in this next rotation studying for USMLE rather than a shelf or the rotation itself. *sigh* i don't want to study for boards again....
EDIT: So I got the resident to send me the picture of the achilles tendon rupture. Its the heel on the right, if the bruise doesn't tip you off, look closely at how the heels are lying. Also notice the tendon 'bump' on the left foot (you an feel it on your own foot) and note how the right is flat. + Homan's sign! BOO YEAH!!
Monday, October 10, 2011
Peds ER: new experiences.
So after a full half of the rotation is over I find I'm disappointed. I'm disappointed with the amount of action that we're seeing (despite my posts mostly its very quiet) and I'm disappointed in my connection with the ER attendings and staff. I am constantly being told that I am 'not thinking about things properly.' And that I need to read more or something. I made well enough friends with the residents, but nothing to hang out after work or whatnot. And it has been made abundantly clear that I am behind my fellow students in aptitude and even the residents know it. There is nothing more frustrating! I hate feeling stupid.
So after a particularly miserable shift, where I didn't seem to be able to answer any of the docs BASIC questions, I decided to cheer myself up with some hot drink at the hospital cafe. I ran into one of the interns from my internal med month. She is an OB/GYN resident (who had to do 1 IM rotation) and she invited to me come up and talk because its been slow.
But before we know it there is a lady who comes in at 6cm dilated and is rocking back and forth in pain. She is 23 y.o. female and is somewhat mentally immature. She was scared out of her mind and it was too late for an epidural because she was rapidly progressing. So i got to witness my first birth, without epidural. Gotta say it was different than expected. It was faster than normal and it was sure painful, but she was less pain and more scared during the majority of it. You could just tell. She was rocking back and forth and crying. She couldn't decide if she wanted her husband there or not. This was even her second child. It was the end that was the big kicker. I guess it was the most painful part. Her legs started shaking uncontrollably and she said it was so much pain she couldn't talk (which was unusual for this patient). Gotta say it made me want to cringe in the corner a bit. I maybe thought that being female wasn't so great after all. The baby did have meconinum (the first baby poo) in HER amniotic fluid, which is dangerous. If the baby cries and breathes before we get it out her mouth then she can breath it in to her lungs and get pneumonia (=bad). So they immediately started suctioning her and tried to keep her from crying. She began to turn blue, so they sucked as much out as they could before she started crying on her own. Usually babies require stimulation (vigorous rubbing) to begin to breathe. It was crazy because when she came out she looked like she was made of jelly or cartilage or something, all white and green and covered in muck. But a couple minutes of breathing she looked like any other baby.
But the baby came out great and the mom didn't tear and had no complications. So overall good night. And one I really wasn't supposed to have... good thing I went for a hot drink.
So after a particularly miserable shift, where I didn't seem to be able to answer any of the docs BASIC questions, I decided to cheer myself up with some hot drink at the hospital cafe. I ran into one of the interns from my internal med month. She is an OB/GYN resident (who had to do 1 IM rotation) and she invited to me come up and talk because its been slow.
But before we know it there is a lady who comes in at 6cm dilated and is rocking back and forth in pain. She is 23 y.o. female and is somewhat mentally immature. She was scared out of her mind and it was too late for an epidural because she was rapidly progressing. So i got to witness my first birth, without epidural. Gotta say it was different than expected. It was faster than normal and it was sure painful, but she was less pain and more scared during the majority of it. You could just tell. She was rocking back and forth and crying. She couldn't decide if she wanted her husband there or not. This was even her second child. It was the end that was the big kicker. I guess it was the most painful part. Her legs started shaking uncontrollably and she said it was so much pain she couldn't talk (which was unusual for this patient). Gotta say it made me want to cringe in the corner a bit. I maybe thought that being female wasn't so great after all. The baby did have meconinum (the first baby poo) in HER amniotic fluid, which is dangerous. If the baby cries and breathes before we get it out her mouth then she can breath it in to her lungs and get pneumonia (=bad). So they immediately started suctioning her and tried to keep her from crying. She began to turn blue, so they sucked as much out as they could before she started crying on her own. Usually babies require stimulation (vigorous rubbing) to begin to breathe. It was crazy because when she came out she looked like she was made of jelly or cartilage or something, all white and green and covered in muck. But a couple minutes of breathing she looked like any other baby.
But the baby came out great and the mom didn't tear and had no complications. So overall good night. And one I really wasn't supposed to have... good thing I went for a hot drink.
Wednesday, October 5, 2011
Peds ER: weird names
okay so i know this has nothing really what to do with medicine but there are some very weird names of some of the patients. And I find I must share them, to remember them later.
- Amgine (Uh mag ine)
- Casonova King and his twin sister Jasonova King
- Marvelous Beltcher
- La-ia (la dash ia)
- Vagina (Vuh geena)
Sunday, October 2, 2011
Peds ER: First Procedure!
So today was pretty exceptional because I got to actually DO something! It was the busiest I've ever seen the peds ER. I actually didn't get dinner. AWESOME!
Not that bad
15 y.o. female comes in with an 'intense' headache since thursday. Had headaches on and off since tuesday that start in the back and then spread over the cortex. Had one episode of vomiting this morning (1am) and has had a temp of 102.4 since this morning despite tylenol and motrin twice a day. She is photophobic and claims to have shooting pains down her neck. It hurts her to tip her chin to her chest. She complains of general myalgias (muscle pain). She has some horizontal nystagmus when looking to the left. Most medical professionals will start thinking meningitis-- at least I did. So I decided to present to the attending instead of the resident to expediate the process. And of course, I was apparently so wrong. He said she didn't look that sick. He said i shouldn't go over the resident's head unless she was really sick. Which apparently it was just a 'bad virus'. I felt very stupid.
The KNEE
17 y.o. male comes in after a football game injury to his knee. It looks like this... (yes, this is the actual knee! we're allowed to take pictures at the hospital!)
He says its painful and is unable to bend it. And the doctor says it needs to be aspirated. And I got to do it!! It was pretty awesome shoving a needle in there and pull ing out over 120cc's of blood. Traumatic bursitis-that's the diagnosis the doc's think. The problem is a bursitis shouldn't be bleeding. He was given dilaudid and started hugging the entire staff as often as he could. Which was sorta adorable. It filled up again within 10 minutes, so we called the ortho guys. Blood should be clotting, by now. So the senior resident comes down and yells at us in front of the patient's mother that we are incompetent and why didn't we aspirate it, and then why didn't we send the aspiration to be cultured. We're like its blood, not an infection. It happened because of an injury. He's like didn't you get an xray? MRI? We're like what else could it be? He's like cancer! And his mother is basically peeing herself at this point. He proceeds to explain that ER docs are the people who couldn't make it in any other specialty. He continued to berate the ER resident about all her decisions and almost had a stroke when she told him I aspirated the knee. The patient told him that he thought I did a good job, but the ortho guy decided to aspirate it himself, which he did and of course it filled up again even bigger than the first time. Then he decided to order and xray and MRI. Which showed blood above the knee cap of course. So he called the attending and she wanted to operate for exploratory surgery.
It was an intense experience. First big argument between physicians that i've witness. I just thought that ortho resident was an ass. But I got to aspirate it! which was awesome...
more later...
Not that bad
15 y.o. female comes in with an 'intense' headache since thursday. Had headaches on and off since tuesday that start in the back and then spread over the cortex. Had one episode of vomiting this morning (1am) and has had a temp of 102.4 since this morning despite tylenol and motrin twice a day. She is photophobic and claims to have shooting pains down her neck. It hurts her to tip her chin to her chest. She complains of general myalgias (muscle pain). She has some horizontal nystagmus when looking to the left. Most medical professionals will start thinking meningitis-- at least I did. So I decided to present to the attending instead of the resident to expediate the process. And of course, I was apparently so wrong. He said she didn't look that sick. He said i shouldn't go over the resident's head unless she was really sick. Which apparently it was just a 'bad virus'. I felt very stupid.
The KNEE
17 y.o. male comes in after a football game injury to his knee. It looks like this... (yes, this is the actual knee! we're allowed to take pictures at the hospital!)
He says its painful and is unable to bend it. And the doctor says it needs to be aspirated. And I got to do it!! It was pretty awesome shoving a needle in there and pull ing out over 120cc's of blood. Traumatic bursitis-that's the diagnosis the doc's think. The problem is a bursitis shouldn't be bleeding. He was given dilaudid and started hugging the entire staff as often as he could. Which was sorta adorable. It filled up again within 10 minutes, so we called the ortho guys. Blood should be clotting, by now. So the senior resident comes down and yells at us in front of the patient's mother that we are incompetent and why didn't we aspirate it, and then why didn't we send the aspiration to be cultured. We're like its blood, not an infection. It happened because of an injury. He's like didn't you get an xray? MRI? We're like what else could it be? He's like cancer! And his mother is basically peeing herself at this point. He proceeds to explain that ER docs are the people who couldn't make it in any other specialty. He continued to berate the ER resident about all her decisions and almost had a stroke when she told him I aspirated the knee. The patient told him that he thought I did a good job, but the ortho guy decided to aspirate it himself, which he did and of course it filled up again even bigger than the first time. Then he decided to order and xray and MRI. Which showed blood above the knee cap of course. So he called the attending and she wanted to operate for exploratory surgery.
It was an intense experience. First big argument between physicians that i've witness. I just thought that ortho resident was an ass. But I got to aspirate it! which was awesome...
more later...
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