Emerg...aka GP clinic for those without doctors
I've worked 5 shifts in emerg so far. I'm enjoying it for the most part. I like that someone comes in and you have to figure out what's wrong with them without knowing them from previous visits. Like a detective! However, in my eyes, it's unfortunate that the emergency department is used like a family practice clinic. I personally see about 20 cases in a shift (the docs see more)...and it turns out that maybe 15% of what comes in is a true emergency...someone is dying or needs surgery or is having a worsening of a previous condition or elderly people with multiple medical problems. The rest can be managed in a GPs office:
Example #1: lady who is pregnant (but doesn't want to be) and having vaginal bleeding for 7 days with some cramping. Probably a miscarriage. What's the emergency you ask? "I just wanted to know for sure". Go home and get your GP to get you an ultrasound.
Example #2: teen girl with crampy-type pain similar to the cramps she had when she got her first period...which was 3.5 weeks ago. No other symptoms except some spotting that started today. You do the math.
Example #3: 22yo male with chest pain. Hurts when he breathes in or moves his arm. Lifted lots of weights yesterday. No other symptoms. Plus, he has an exam at school today. "Am I having a heart attack?" he asks. No. You should have studied more. Go home.
Example #4: (it's 2am) 8yo child with runny nose, fever and sore throat. Still eating, drinking, peeing, and pooping. Decreased energy. "I was worried because she wasn't herself lately and she has a fever" Yup, she sure does. She's got a virus. It's called a cold. Go home and give her tylenol.
But there's been a few memorable cases in my last couple shifts:
#1: I was asked to see a 57yo lady who came in with chest pain (doesn't really matter why she was there). The doctor and nurse were smirking when they asked me to see her. "Great", I thought. It's probably some Borderline personality or something like that (those people rub me the worng way). The doctor says to me "pay particular attention to your physical exam". So, I go take the history from the lady (no medical 'problems'), and I notice she is in no acute distress. I notice she has the ECG stickers on her right side (instead of the usual left), so I thought she had a heart attack on the back side of her heart. I listen to her heart sounds in the normal spots. The ones close to her sternum are there, but much fainter than I expected. The ones on the far left side of her chest wall weren't there. Period. Me: puzzled. I listened to her breathing and heard heart sounds on the right!!! WHAT THE F**K?!?!?!??! I examine her abdomen and find the surgical scars from a liver cyst removal...on the LEFT side (for the non-med people out there...the liver is on the RIGHT and the heart is on the LEFT). Diagnosis: Situs inversus. She has all her internal organs reversed compared to 'normal' people. I will probably never see another case of this in my career. Cool!
#2: Performed CPR for the first time Friday night in a Code Blue. 53yo lady with a bad heart (dilated cardiomyopathy) who has been on a transplant list for 6 years. Her and her 16yo daughter were having a verbal argument when she collapsed. Paramedicas were there within 4 minutes to do CPR and it took 17 minutes before getting to the hospital. We shocked her a couple times and got her back, but it doesn't look good. Code Blue's are surprisingly calm considering the magnitude of what's happening.
#3: treated the mother of a former provincial Premier. She was my patient and wasn't too clear of why she was there, so I met the Premier and got more history from him. Very nice man. His mom will be OK.
Example #1: lady who is pregnant (but doesn't want to be) and having vaginal bleeding for 7 days with some cramping. Probably a miscarriage. What's the emergency you ask? "I just wanted to know for sure". Go home and get your GP to get you an ultrasound.
Example #2: teen girl with crampy-type pain similar to the cramps she had when she got her first period...which was 3.5 weeks ago. No other symptoms except some spotting that started today. You do the math.
Example #3: 22yo male with chest pain. Hurts when he breathes in or moves his arm. Lifted lots of weights yesterday. No other symptoms. Plus, he has an exam at school today. "Am I having a heart attack?" he asks. No. You should have studied more. Go home.
Example #4: (it's 2am) 8yo child with runny nose, fever and sore throat. Still eating, drinking, peeing, and pooping. Decreased energy. "I was worried because she wasn't herself lately and she has a fever" Yup, she sure does. She's got a virus. It's called a cold. Go home and give her tylenol.
But there's been a few memorable cases in my last couple shifts:
#1: I was asked to see a 57yo lady who came in with chest pain (doesn't really matter why she was there). The doctor and nurse were smirking when they asked me to see her. "Great", I thought. It's probably some Borderline personality or something like that (those people rub me the worng way). The doctor says to me "pay particular attention to your physical exam". So, I go take the history from the lady (no medical 'problems'), and I notice she is in no acute distress. I notice she has the ECG stickers on her right side (instead of the usual left), so I thought she had a heart attack on the back side of her heart. I listen to her heart sounds in the normal spots. The ones close to her sternum are there, but much fainter than I expected. The ones on the far left side of her chest wall weren't there. Period. Me: puzzled. I listened to her breathing and heard heart sounds on the right!!! WHAT THE F**K?!?!?!??! I examine her abdomen and find the surgical scars from a liver cyst removal...on the LEFT side (for the non-med people out there...the liver is on the RIGHT and the heart is on the LEFT). Diagnosis: Situs inversus. She has all her internal organs reversed compared to 'normal' people. I will probably never see another case of this in my career. Cool!
#2: Performed CPR for the first time Friday night in a Code Blue. 53yo lady with a bad heart (dilated cardiomyopathy) who has been on a transplant list for 6 years. Her and her 16yo daughter were having a verbal argument when she collapsed. Paramedicas were there within 4 minutes to do CPR and it took 17 minutes before getting to the hospital. We shocked her a couple times and got her back, but it doesn't look good. Code Blue's are surprisingly calm considering the magnitude of what's happening.
#3: treated the mother of a former provincial Premier. She was my patient and wasn't too clear of why she was there, so I met the Premier and got more history from him. Very nice man. His mom will be OK.

2 Comments:
At 11:44 PM,
Anonymous said…
hey you, finally... about time you posted. Once you in pediatrics, you will see dexicardia right and left... but right mostly...
Try to get cardiology peds rotation if you find it interesting.
At 6:14 PM,
Anonymous said…
just a thought about the miscarriage lady, they can bleed pretty vigorously...
it can be extremely frustrating to work emerg and never see a true emergency and of course it is terribly inefficient for the health care system, but there just aren't enough GPs out there and accessing tests from the community can be extremely difficult.
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