The first is a mystery overdose. This is always why ER docs get paid the big bucks because no other doctor does this part of things (aka- if we have no information or even guesses they send in the ER doc). The patient isn't exactly unconscious but she might as well be. All we know is she took some pills. She's seizing and doesn't really know what's going on around her. Her blood pressure is a roller coaster of too high and too low and nobody seems to be able to tantalize her enough to get her to the ICU. It also doesn't help that her husband and her boyfriend are screaming at each other arguing over what she took and whose fault it was. We talk to them separately and they give us two different stories of what she could have taken. It gets frustrating. In the end, I get a list of all of the meds they had in their house and start looking up toxidromes for all of them. I figured out that bendryl was among the things she took as was wellbutrin, an anti-depressant and anti-smoking drug that increases your likelihood of seizing. Neither of these drugs have a reversal agent so to start, i just recommended fixing all the electrolyte abnormalities that could cause a seizure-- like too low sodium or too high potassium. Eventually the seizures did finally slow and the lady admitted to taking aspirin as well. We quickly gave the antidote although it may not be as effective because of how much time went by. She finally went up to ICU and i never found out if she made it.
There was also an elderly male who came in with hypotensive crisis with multiple bouts of nausea and vomiting lasting over 2 months. We couldn't figure out why and apparently neither could anyone else. We had given him 2 liters of fluid and mulitple pressors and still he wasn't getting better. He was in renal failure and had been getting worse because of his diabetes. It turns out he also had a heart attack 2 years ago and was on a huge regimen of meds. In a very cool last ditch effort, on the docs gave a 5mg bolus of glucagon which is the antidote to Beta blockers (a heart medication), which fixed him right up. Apparently, because the kidneys were failing and were unable to clear the beta blockers out of his system so everytime he took a pill it was increasing in his system rather than clearing. He had so many in his system that his heart simply couldn't recover and therefore it was getting worse and worse. Talk about a very cool last ditch effort. Way to throw the kitchen sink at him.Also here is a photo of this 8yo's rash, you should know rashes are an ER docs worst nightmare because we see them all the time but really derm is so subjective and so random that it is hard to diagnose and seems almost impossible to treat. So most docs run the other way or force the medical student to deal with it. (ahem). So this rash literally covered him from head to toe for the past month. The reason I got to take a picture of it was because nobody could figure out what it was. He had been to other ERs where they'd established: it wasn't hives. It wasn't scabies. and it wasn't poison ivy. no viral symptoms. All of which he had been treated for before today with no improvement. His rash was getting worse and he hadn't had any meds for a week. So we admitted him because we didn't know what else to do. This poor kid had to deal with these all over himself and nobody had any idea how to help. The sad part about being an ER doc: Never did figure out what it was. Hope they figured it out eventually.
Now that i'm almost officially done with this audition rotation, I don't have anything clever to say. I don't know how I did or what they think of me. In general, I just am fearing studying for my next liscensing exam. SO much so that I sorta just.... don't. Which is very very bad. Also the application program that allows us to apply for residencies opened. And I still don't have my personal statement (the essay that states why I want to be an ER doc) written. Or even a good idea conceived. *sigh* So much to do and so much apathy....
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