More tales from the ER

I had a good day yesterday. I worked with my site coordinator in the 'treatment' or fast tract area. This is where people come for injuries and other problems that aren't too serious/acute/they-may-die-because-of-this. I like it because generally it's a quicker turnover, not much needs to be investigated (ie bloodwork, etc) and most are discharged. Also there are more procedures like suturing and casting. But it was pretty slow (the bad 'S' word of emerg). The hospital was full, so anyone that was bein admitted had to wait in emerg until they went to the ward, which meant that we couldn't see new patients unless they were dying now. The ER was essentially backed up. The treatment area was slow because no one had come in. I saw maybe 6 cases all day.

On one of the cases I had to suture this sweet elderly man who had tripped getting out of his vehicle and smashed his head on the pavement. He had had a stroke previously and was left with some deficits, but definately was not missing his humor! I might just have a date for Valentines! But while I sutured, a second year med student was there as part of one of her classes and asked to watch me. So I walked her through suturing from start to finish (examining the wound, choosing sutures, putting on sterile gloves, sterile/clean procedures, local anesthetics, etc). Just like all the surgeons I've been with, I let her cut the sutures!!!! We were also told to see a patient who had come in and had an ankle injury. As we both did the history, I pretty much knew the diagnosis from the mechanism of injury, I asked her what her differential diagnosis was (it was a ruptured achilles tendon). I got her to show me her ankle exam as a precpetor would do with me. Even though I am only one year ahead of her, I can't believe the difference!!!! Make me realize how much I've learned/seen/done in the past year! I also realized how much I like teaching and hope to be a preceptor when I am a practicing physician.

I also reduced a dislocated shoulder (ie put the should back in its socket) by myself, under supervision of course. I had done 2 already in previous shifts so I was familiar with what to do. I called for a respiratory therapist, a nurse, and 100cc of propofol (lovely clean anesthetic/amnestic that doesn't cause respiratory depression). I gave the propofol when everyone was ready, the guy went out like a light and we put his shoulder in after a few attempts. Then the patient woke up and was much more comfortable. That drug looks so fun!!!

And I saw a lady with a paper cut. No joke. I cured her...with a bandaid. I hope it was worth her 2 hour wait.