This weekend, I was in the ER from 7am-5pm on both Saturday and Sunday. Surprisingly, it wasn't too crazy! Maybe it would have been busier, or there would have been more traumas that came in, if I was there overnight. As it was, though, I still got to see and do a lot.
The most interesting case from this weekend was actually the first one I saw on Saturday. It was a girl who was the same age as me who had attempted suicide by cutting her arm in a few places with a kitchen knife. Needless to say, this was a pretty touchy situation, and she was just quiet and subdued the whole time she was there. When I was stitching her up, she hid under a blanket and refused to look at her arm. She got 17 stitches total over four cuts, and a referral to an inpatient facility since that's the policy at the hospital I'm at. I hope everything goes well for her.
Another interesting case was when one man collapsed in the parking lot and went into cardiac arrest right outside the ER door. He was quickly brought into a trauma bay and resuscitated with CPR and defibrillation. After he was stabilized and put on a ventilator, he was admitted to the hospital, and I don't know what happened to him after that. But, he was alive when he left the ER, and that fact alone is pretty incredible!
Other than those two cases, there was nothing else super interesting or eventful. The rest of the patients were, as usual, either adults with something quick and easy to fix or older people with so many chronic conditions and vague symptoms that they just got admitted to rule out anything crazy. The big scary things (heart attack, pulmonary embolism, stroke, aortic aneurysm) can present very differently in older people, so most people with a couple chronic conditions (basically everyone) gets the workup for all of those things.
I really like the ER! I'm pretty surprised that I like it as much as I do, because I was dreading this rotation initially. But, it's pretty much always busy, and there's always something interesting to think about. I'm actually wishing I had only two weeks in urgent care and three weeks in the actual ER, because it's so interesting and everyone at the hospital I'm at is pretty nice.
Anyway, that's it for today. Just two more shifts left - tomorrow 7am-5pm and Wednesday 12pm-10pm! Then I'm headed to Kansas for a four-day weekend with my amazing boyfriend before my next rotation starts! :)
Monday, October 28, 2013
Thursday, October 24, 2013
First three shifts in the ER!
Sorry I didn't update sooner, like I promised! The first day felt long, and I had two night shifts right after that, and between being tired and having some assignments to do for school, I just didn't feel like posting. Plus, the ER was nowhere near as dramatic as I feared it was going to be!
On my first day, I was with a PA, which was really nice. It was actually the first time I'd worked with a PA or even seen one in action since shadowing in college. He was really nice, and let me do a lot! I would go see each patient first, then present to him, then he would go see them and we would decide together what would be best to do. Unlike working with doctors, he actually seemed to value any input I had in terms of what should be done for workup, which was nice. Of course, I still have a lot to learn, but at least he asked me what I thought! We didn't see anything too stressful - a couple people with chest pain that wasn't likely to be a heart attack or pulmonary embolism (MI and PE, respectively, for future reference), some dental abscesses (way more common than I would have thought), one guy with pneumonia, and a couple hypochondriacs. Like I said, nothing too thrilling. What was interesting was how crazy busy the ER was! That first day, I was there from 8am-6pm, and people were just running all over the place all the time. Not really in a stressful life-saving way, just a busy way. It runs like a well-oiled machine!
My second day, I was there for a night shift (5pm-3am) with a resident. This particular resident was a little socially awkward and kind of timid at signing up for patients, so we only saw about seven people over the course of the 10-hour shift. There was a lot of downtime, especially toward the end of the shift, which made it even harder to stay awake! Our patients weren't even very exciting - mostly hypochondriacs, with one very intoxicated guy thrown in. So that night wasn't very fun, and trying to find street parking within a half-mile of my apartment at 3:30am when it was over was the icing on the cake.
But! Last night I worked the 5pm-3am shift again, this time with a different resident, and had a completely different experience. This resident was really nice, and totally on top of signing up for patients, so we were busy pretty much the whole shift. He also signed up for a trauma patient, which was exciting! There was a car accident with a bunch of young college girls (they got rear-ended by a drunk driver and the car flipped), and they all ended up in the trauma bay. No serious injuries - the girl we worked on just had a big cut on her knee. So I got to clean that up and put in a couple stitches, which was good! All of the other girls were fine, too, just scared. Other than that, we saw a bunch of dental abscesses, a nurse who passed out on the job and turned out to be pregnant, some chest pain cases, and a guy with HIV and a productive cough, so most likely PCP pneumonia (common in immunocompromised patients). The time seemed to fly by, and it was a much more interesting night!
Now, I have two days off before going back in on both Saturday and Sunday from 7am-5pm. Hopefully the weekends are busy!
On my first day, I was with a PA, which was really nice. It was actually the first time I'd worked with a PA or even seen one in action since shadowing in college. He was really nice, and let me do a lot! I would go see each patient first, then present to him, then he would go see them and we would decide together what would be best to do. Unlike working with doctors, he actually seemed to value any input I had in terms of what should be done for workup, which was nice. Of course, I still have a lot to learn, but at least he asked me what I thought! We didn't see anything too stressful - a couple people with chest pain that wasn't likely to be a heart attack or pulmonary embolism (MI and PE, respectively, for future reference), some dental abscesses (way more common than I would have thought), one guy with pneumonia, and a couple hypochondriacs. Like I said, nothing too thrilling. What was interesting was how crazy busy the ER was! That first day, I was there from 8am-6pm, and people were just running all over the place all the time. Not really in a stressful life-saving way, just a busy way. It runs like a well-oiled machine!
My second day, I was there for a night shift (5pm-3am) with a resident. This particular resident was a little socially awkward and kind of timid at signing up for patients, so we only saw about seven people over the course of the 10-hour shift. There was a lot of downtime, especially toward the end of the shift, which made it even harder to stay awake! Our patients weren't even very exciting - mostly hypochondriacs, with one very intoxicated guy thrown in. So that night wasn't very fun, and trying to find street parking within a half-mile of my apartment at 3:30am when it was over was the icing on the cake.
But! Last night I worked the 5pm-3am shift again, this time with a different resident, and had a completely different experience. This resident was really nice, and totally on top of signing up for patients, so we were busy pretty much the whole shift. He also signed up for a trauma patient, which was exciting! There was a car accident with a bunch of young college girls (they got rear-ended by a drunk driver and the car flipped), and they all ended up in the trauma bay. No serious injuries - the girl we worked on just had a big cut on her knee. So I got to clean that up and put in a couple stitches, which was good! All of the other girls were fine, too, just scared. Other than that, we saw a bunch of dental abscesses, a nurse who passed out on the job and turned out to be pregnant, some chest pain cases, and a guy with HIV and a productive cough, so most likely PCP pneumonia (common in immunocompromised patients). The time seemed to fly by, and it was a much more interesting night!
Now, I have two days off before going back in on both Saturday and Sunday from 7am-5pm. Hopefully the weekends are busy!
Sunday, October 20, 2013
Time for the ER!
Well, I'm all done in urgent care, and after a refreshing weekend at home, it's time to start in the ER as the second part of my emergency medicine rotation! My first shift is 8am-6pm tomorrow, so that's pretty normal, but then I have some night ones (5pm-3am) that should be pretty interesting. I've always been a morning person, and my productivity and attention span definitely dwindles at night, so hopefully I'll be able to reset my internal clock for a few days!
My last couple of shifts in the urgent care were great! I got to see a couple interesting things, and still got to manage some more "typical" urgent care cases. I got to sew my first face - a woman had fallen in her bathroom that morning, and had a 1.5-inch laceration through her eyebrow that I got to stitch up! It turned out great, and she was very happy with my work, which is always nice.
Something else that was pretty satisfying was correctly diagnosing a couple of different skin rashes - a lot of them look the same, and most urgent care/ER/primary care docs who see rashes just try to throw a steroid cream at it and hope it goes away, because they can't tell what it is. But! I recognized two different rashes that I learned about in school, which was pretty awesome. It's definitely rewarding to realize that something you studied in school paid off!
Other than those cases, there wasn't too much excitement in the urgent care last week. I'll post an update tomorrow on how my first ER day goes - I'll be with a PA, and I've heard that they tend to see more urgent care-type cases (at least at this hospital), so it might be more of the same things I've already seen. The remainder of my shifts in the ER are with doctors, though, so I will definitely get to see some trauma and more life-threatening things. Part of me is excited for it, but I'm also definitely a little scared! I'm sure no one will let me do anything that matters too much, which is reassuring at least. I'll post an update tomorrow!
My last couple of shifts in the urgent care were great! I got to see a couple interesting things, and still got to manage some more "typical" urgent care cases. I got to sew my first face - a woman had fallen in her bathroom that morning, and had a 1.5-inch laceration through her eyebrow that I got to stitch up! It turned out great, and she was very happy with my work, which is always nice.
Something else that was pretty satisfying was correctly diagnosing a couple of different skin rashes - a lot of them look the same, and most urgent care/ER/primary care docs who see rashes just try to throw a steroid cream at it and hope it goes away, because they can't tell what it is. But! I recognized two different rashes that I learned about in school, which was pretty awesome. It's definitely rewarding to realize that something you studied in school paid off!
Other than those cases, there wasn't too much excitement in the urgent care last week. I'll post an update tomorrow on how my first ER day goes - I'll be with a PA, and I've heard that they tend to see more urgent care-type cases (at least at this hospital), so it might be more of the same things I've already seen. The remainder of my shifts in the ER are with doctors, though, so I will definitely get to see some trauma and more life-threatening things. Part of me is excited for it, but I'm also definitely a little scared! I'm sure no one will let me do anything that matters too much, which is reassuring at least. I'll post an update tomorrow!
Sunday, October 13, 2013
Lots of suturing, and a weekend shift!
Sorry it's been so long since the last update! Like everything else, even urgent care gets routine after a while. Plus, my schedule has been pretty sporadic, so there never feels like a good time to write a post.
This past week wasn't too exciting, really, but I did get to do a lot of suturing! On Monday, I got to sew up a woman's arm in four places after she got bit by a dog. Fun fact: dog bites are way less likely to get infected (3-5%) than cat bites (70%) and human bites (80%)! So even though your gut might tell you that sewing up a bite wound is wrong, it's most likely going to be fine if it was a dog that had all its shots. Anyway, that woman got 11 stitches. Right after she left, a man came in after getting sliced in the arm with a piece of sheet metal at work, and he got 8 stitches from me. My preceptor let me do everything - cleaning out the wound, numbing the area, sterilizing the area, and sewing it up! Both patients were also super nice, and easy to talk to, which is good because the whole thing probably took me 45 minutes for the woman and 30 for the man.
Other than that, I've seen a lot of foot/ankle/knee pain this week, so I'm getting pretty good at evaluating that, and remembering all the "special tests" for the knee to figure out which ligament is sprained. We also saw a lot of kids coming in with a "boxer's fracture" (a break in the 4th or 5th metacarpal bone - the hand bones below the pinky and ring fingers) from punching walls! I think we saw three in the same day.
There definitely seem to be themes on any given day - so far, there's been corneal abrasion day, diffuse knee pain with no prior injury (AKA attention-seeking...or a DVT) day, upper respiratory infection day, etc. I worked yesterday, and weekends are definitely much slower than weekdays, which surprised me. I thought people would be more likely to come in on the weekend because they wouldn't have work or other obligations, but apparently not! Over eight hours yesterday (10am-6pm), we only saw 10 people. For reference, on a regular 12-hour day during the week, we usually see 20-24. So, yesterday was pretty slow. Luckily, I have my own computer and bring books to study with, so I never feel like my time is wasted! Plus, everyone that works at the urgent care is nice and fun to hang out with.
I'm working again today from 10am-6pm, and then two more twelve-hour shifts on Tuesday and Thursday. It's not a bad life! Then, next week I start in the actual ER, and I still don't know my schedule for that. I've heard that most people use the ER as an urgent care, so it might not be very different than what I've already seen. I may get to see some major traumas or chest pain/stroke patients though, so it should definitely be a learning experience!
This past week wasn't too exciting, really, but I did get to do a lot of suturing! On Monday, I got to sew up a woman's arm in four places after she got bit by a dog. Fun fact: dog bites are way less likely to get infected (3-5%) than cat bites (70%) and human bites (80%)! So even though your gut might tell you that sewing up a bite wound is wrong, it's most likely going to be fine if it was a dog that had all its shots. Anyway, that woman got 11 stitches. Right after she left, a man came in after getting sliced in the arm with a piece of sheet metal at work, and he got 8 stitches from me. My preceptor let me do everything - cleaning out the wound, numbing the area, sterilizing the area, and sewing it up! Both patients were also super nice, and easy to talk to, which is good because the whole thing probably took me 45 minutes for the woman and 30 for the man.
Other than that, I've seen a lot of foot/ankle/knee pain this week, so I'm getting pretty good at evaluating that, and remembering all the "special tests" for the knee to figure out which ligament is sprained. We also saw a lot of kids coming in with a "boxer's fracture" (a break in the 4th or 5th metacarpal bone - the hand bones below the pinky and ring fingers) from punching walls! I think we saw three in the same day.
There definitely seem to be themes on any given day - so far, there's been corneal abrasion day, diffuse knee pain with no prior injury (AKA attention-seeking...or a DVT) day, upper respiratory infection day, etc. I worked yesterday, and weekends are definitely much slower than weekdays, which surprised me. I thought people would be more likely to come in on the weekend because they wouldn't have work or other obligations, but apparently not! Over eight hours yesterday (10am-6pm), we only saw 10 people. For reference, on a regular 12-hour day during the week, we usually see 20-24. So, yesterday was pretty slow. Luckily, I have my own computer and bring books to study with, so I never feel like my time is wasted! Plus, everyone that works at the urgent care is nice and fun to hang out with.
I'm working again today from 10am-6pm, and then two more twelve-hour shifts on Tuesday and Thursday. It's not a bad life! Then, next week I start in the actual ER, and I still don't know my schedule for that. I've heard that most people use the ER as an urgent care, so it might not be very different than what I've already seen. I may get to see some major traumas or chest pain/stroke patients though, so it should definitely be a learning experience!
Wednesday, October 2, 2013
Emergency Medicine is a crazy ride!
My emergency medicine rotation started this week, and it has been crazy! My schedule is a little sporadic - I have three or four 12-hour shifts each week. For the first three weeks of my rotation I'm at an Urgent Care center and all of my shifts are 10 a.m. to 10 p.m., and the last two weeks will be in the actual Emergency Department in a hospital in downtown Pittsburgh.
So, this week I've already worked two 12-hour shifts, and have today off, which I desperately needed. Twelve hours, plus the never-accounted-for extra time at the end of the day for finishing paperwork and getting those last patients out, plus a 25-30 minute commute, is much more taxing than my last rotation!
The Urgent Care center I'm at right now is really great for learning because there's only ever one doctor there, so I just work with the doctor. That means I get to see more or less all of the patients that come through, and it can be a lot! The last two days, I think we had about 20-24 patients per 12-hour shift. Since it's Urgent Care and not an ER, I haven't seen anything too stressful or life-threatening, though we did have to send some people with chest pain over to the actual ER for further evaluation. I have seen plenty of corneal abrasions, ankle sprains/fractures, finger fractures, finger lacerations, a few cases of vertigo, and some abdominal pain. The doctors that work there are good about letting students do things, so I've done a bunch of injections (just tetanus boosters for people with cuts or burns), some suturing, and some eye staining/examination for the people with corneal abrasions. I've always loved eyes, and I finally got to use the slit lamp - the machine used by eye doctors - and it was so cool!!
I have noticed that the doctors here are more brusque than the other doctors I've worked with, and I'm not sure if that's the nature of medicine in a city, or just the nature of the typical ER doctor. They're still nice, but way more fast-paced and serious. Also, a LOT more tests and procedures are ordered here than would have been ordered in a place like Kentucky. The doctor I was working with on Monday told me that patient satisfaction is really important, and a lot of patients don't really care if a test is necessary or not, but will feel better if more is done. So...for example, a younger guy came in on Monday with a cough and sore throat...that had only started about four hours before he came in. It wasn't anything out of the ordinary for him, and his physical exam was fine. In Kentucky, he would have been told that he had a cold and it would clear up in a few days, and to take over-the-counter decongestants and cough medicine if he wanted. In Pittsburgh.....he got a chest X-ray and an inhaler to take home, and a note to get out of work for the afternoon. Talk about the rising costs of healthcare!!
But, I love the nature of Urgent Care. Lots of procedures, and most things are pretty quick fixes that leave people happy! Also, it's not super stressful because, like I said before, nothing is life-threatening. I'll get to see that in a couple of weeks, and I'll be glad to have that experience too, but for now I am perfectly happy diagnosing fractures and giving tetanus shots. I also love driving back into Pittsburgh at night - the skyline is so beautiful, and the city feels alive! I'm definitely glad to be back here. :)
So, this week I've already worked two 12-hour shifts, and have today off, which I desperately needed. Twelve hours, plus the never-accounted-for extra time at the end of the day for finishing paperwork and getting those last patients out, plus a 25-30 minute commute, is much more taxing than my last rotation!
The Urgent Care center I'm at right now is really great for learning because there's only ever one doctor there, so I just work with the doctor. That means I get to see more or less all of the patients that come through, and it can be a lot! The last two days, I think we had about 20-24 patients per 12-hour shift. Since it's Urgent Care and not an ER, I haven't seen anything too stressful or life-threatening, though we did have to send some people with chest pain over to the actual ER for further evaluation. I have seen plenty of corneal abrasions, ankle sprains/fractures, finger fractures, finger lacerations, a few cases of vertigo, and some abdominal pain. The doctors that work there are good about letting students do things, so I've done a bunch of injections (just tetanus boosters for people with cuts or burns), some suturing, and some eye staining/examination for the people with corneal abrasions. I've always loved eyes, and I finally got to use the slit lamp - the machine used by eye doctors - and it was so cool!!
I have noticed that the doctors here are more brusque than the other doctors I've worked with, and I'm not sure if that's the nature of medicine in a city, or just the nature of the typical ER doctor. They're still nice, but way more fast-paced and serious. Also, a LOT more tests and procedures are ordered here than would have been ordered in a place like Kentucky. The doctor I was working with on Monday told me that patient satisfaction is really important, and a lot of patients don't really care if a test is necessary or not, but will feel better if more is done. So...for example, a younger guy came in on Monday with a cough and sore throat...that had only started about four hours before he came in. It wasn't anything out of the ordinary for him, and his physical exam was fine. In Kentucky, he would have been told that he had a cold and it would clear up in a few days, and to take over-the-counter decongestants and cough medicine if he wanted. In Pittsburgh.....he got a chest X-ray and an inhaler to take home, and a note to get out of work for the afternoon. Talk about the rising costs of healthcare!!
But, I love the nature of Urgent Care. Lots of procedures, and most things are pretty quick fixes that leave people happy! Also, it's not super stressful because, like I said before, nothing is life-threatening. I'll get to see that in a couple of weeks, and I'll be glad to have that experience too, but for now I am perfectly happy diagnosing fractures and giving tetanus shots. I also love driving back into Pittsburgh at night - the skyline is so beautiful, and the city feels alive! I'm definitely glad to be back here. :)
Subscribe to:
Posts (Atom)