So I spent last night from 8pm to 7am this morning in a local emergency room doing a rotation. It was by far the most exciting and educational evenings of my medical career so far...here's a summary of the patients I got to see:
1) 54 yo F presented with chest pain and HA
PMH (past medical history) of Hypercholesterol, HTN (high blood pressure), Asthma, CHF (congestive heart failure also incredibly stressed and worried about everything in Haiti...which we later found out was b/c she's from there and still has family there
ordered a CT chest w/ contrast...
--> cardiomegaly, CHF
admitted
she was my first pt....great pt...actually using her for my write up
interestingly....around 6 this morning we're called upstairs b/c she's losing it....we get up there and it was like she had ODed on opiods or something
they still hadn't figured it out when we left...but she was perfectly alert and oriented a few hours prior....maybe the husband gave her some of her regular meds before he went home and it messed her b/c she was already receiving lasix IV, tylenol, and nitropaste
2) 19yo female - can't swallow and throat hurts...DXed with strep throat monday...tongue had some erosion that almost looked like a Candida infxn but once you depressed the tonge, the tonsils were so swollen they were nearly occluding the entire throat....hence the dysphagia
3) 73yo M with rectal and penile bleeded...go pulled away from him though to go to a code blue for a
90 yo F found in asystole (flatline)...gave epinephrine and atropine, 3 rounds with chest compressions and bag ventilation throughout...
which is where stuff got awesome...CPR person got tired...Dr asked if we knew how, I said yes, he said "get your gloves on, let's go" so i gave compressions, then D gave some, and the woman after a while came out of asystole and got a rhythm back....so i'm feeling nothing in this womans femoral artery for the longest time and then finally she gets a bounding pulse with the last dose of atropine....absolutely insane!
4) 66 yo F attacked near her home, didn't let go of her purse so the criminal stabbed her with something in the arm...had to get an xray and sutures
5) 29 yo creole woman that didn't speak english...substernal pain, pain uder right breast, and pain in the pelvic region, especially after sex...ended up being nothing that they could figure out though
6) 67 yo M with severe backpain, PMH: HTN, pending prostate biopsy, nothing showed up on CT of abdomen, pelvis, or chest
7) 71yoF PMH: HTN, DM, Arthritis came in with SOB, chest tightness...had a CXR but didn't come back before we left
8) 36 yo F PMH: schizoaffective, reported listening to the spirits and voices and walking around for 3 days but she was at a bus stop and had fallen and hit her head...CT cervical spine w/o contrast, CT head or spine w/o contrast, CXR...ended up with C2 fracture (she broke her second vertebrae in 3 pieces...this is the same vertebrae that Christopher Reeves was affected by)...the freakin dens was broken in 3 pieces...it was crazy...so we needed her to lay still to preserve the spinal cord...but she had been on neuroleptics long enough that she had developed tardative dyskinesia (makes the patient twitch, almost like Tourettes) so it was hard for her to sit still...
9) 38 yo M PMH: schizophrenia, HTN, depression - having suicidal thoughts, missed his meds yesterday, girlfriend died 7 months ago...not sure what they did with him...he was still there when we left
10) 19 day old baby boy (adorable) running a fever...so protocol if they're under 30 days is to do a full septic work up, which includes a spinal tap...but it was amazing how much better it was for an infant...they don't have to use as big of a needle and the baby doesn't really feel as much of the pain
So that was what I got to do last night...first time seeing all this mumbo jumbo I have to learn really put into practice...and I LOVED EVERY SECOND OF IT!!!!
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