It’s a good thing there’s only one more night shift left, because I’m not really functional anymore. (And if this post comes out looking weird, I’m sorry, the computer has chosen the one hour that I have for blogging and arranging interview stuff to go on the fritz, and refuse to open anything. . . )

Last night there was an MVC leading to four patients on backboards arriving in the ER at once. The first one was most likely to be injured, and got there five minutes before the others, so I watched Dr. Dimant assess him. When the other three arrived, and she was still busy with the first, I went with the one complaining of abdominal pain (ok, 1 out of 10, but still most likely to be serious) and did the trauma assessment in order. I was very pleased with myself; I checked all of the important things (yes, I didn’t realize that by poking the patient’s teeth Dr. Dimant was assessing for LeFort facial fractures, so I skipped that), and made sure that the patient was perfectly fine, just a bad driver. I also assessed one of the other passengers, who was also mostly fine. Dr. Dimant then repeated everything, but I satisfied myself that, when the patients are clearly uninjured, I can remember and go through the ABCDE thing. Very nice of them all to come spend four hours in our ER so I could practice that.

Later, I saw a guy complaining of hypertension. He’d been checking his blood pressure at home for three days, and it was definitely elevated, although not to the point of a hypertensive emergency. The trick was that, although fairly young, he had an immense history of strokes and silent MIs. He had been seen in another ER a few days before, but by the time they got to him, his blood pressure had normalized, and he was sent away. We ordered an EKG, cardiac enzymes, and chest xray, expecting them to be normal. I went to see a little old lady who was shaking away with a high fever, and was fairly delirious, although her companion didn’t seem to notice anything extraordinary in her disjointed conversation.

About the time when her O2 sats started edging downwards, and her heart monitor started to be full of PVCs and other arrhythmias, the first guy’s EKG came back with peaked T waves and ST elevations. Dr. Dimant did not appreciate me attempting to panic about the little old lady while the other guy was having a heart attack. She spent 45 minutes trying to get him straightened out. When she found fractured ribs on his xray, and he said that oh yes, he’d been struck by a car several days ago, but hadn’t bothered to see a doctor, and had forgotten all about it, she decided that he was too unreliable a historian to risk giving any thrombolytics too, and hastened to transfer him to the big city. Of course, as soon as she came to look at my lady, her O2 sats stabilized, and her rhythm became beautiful. I think attendings have a magic potion for stabilizing patients.

Lastly, there was a young man with a couple large abscesses which he had been attempting to lance himself. We gave him a stern lecture on the subject of trying to make MRSA go away by waving a razor at it, and were about to take care of it properly, when Dr. Dimant decided he was so thin, and the abscesses were so close to some vital structures, that she wanted a CT scan before cutting in too deeply. And I had to leave before the report came back. Bother it. All the drunks and overdoses insisted on breathing on their own today, too, although there was a frequent flyer who’s been intubated every other time he’s been here in the last three months; but not on my shift.

One other patient: a girl complaining of severe depression since having an abortion a few weeks ago. Dr. Dimant and I saw her together. I wanted very badly to go at least try to talk about Jesus and forgiveness with her, but I didn’t think the attending would appreciate me disappearing to do that when there were other patients I was supposed to be seeing, so I asked her about it, and she said she wouldn’t mind, but she would want to be in the room. And since she didn’t get any quiet time after that, it didn’t happen.

Advertisements