When I was a medical student, I did orthopedic surgery as my surgical sub-internship. Rounds on patients consisted of little more than an assessment of peripheral pulses and a glance at the INR (measure of coagulation) to determine that evening's warfarin dose. Stable patients received an EFD - Exam from doorway. Just a peek in, make a diagnosis and off you go. Today kind of reminded me of that.
I had a new attending today. It was quite a trip. We had a not-so-busy-morning, and he would send me to see every patient that came in. That was no big deal, but it was interesting to see that he almost always had the discharge paperwork ready before I even presented the patient to him... We did real well keeping patients coming in and out until about lunch time, then suddenly 3 ambulances and a somewhat critical patient all arrived around the same time.
The diagnoses today:
- contact dermatitis: yep, even in winter, poison ivy plants are around. To keep in mind: men who scratch everywhere get rashes wherever they scratch. WHEREVER they scratch. Just had to smile and move on...
- fractured PICC line: my theory continues to be, if you have metastatic cancer of any kind, in this case renal cell carcinoma with metastases to bone, you can have anything you want. One of the bummers is having your central line crack and leak causing you discomfort. We pulled the line, and they will come in on Monday to have it replaced.
- eye laceration: I actually don't see a lot of mentally challenged patients. This one came from a local group home. He has a condition that makes him wheelchair bound and spastic. So spastic he whacked his head on the side of the bath when he was being washed and had a cut. It's the first time I've had to apply glue to a wound on a moving target. I got the edges together. Not my best job, but it will do the trick.
- otitis media: Moms who have sick kids can end up getting sick too. Three small children at home all with colds. Mom finally made it in and has an ear infection. Some antibiotics will help her medically.
- bronchitis: Some of the drugs that best help can also hurt. My patient had a heart attack several months back and is on blood thinners for his stent and heart. He's been coughing a lot and today came in because he had coughed up 2 large clots of blood. We made sure he didn't have anything else going on, and then I lectured him on the hazards of smoking because his lungs were starting to look like Swiss cheese on his CAT scan. He might listen... might.
- pneumonia: When we decide to order tests and studies, it's based on clinical suspicion. Words like crushing chest pain, non-mobile and one-sided swelling trigger thoughts of DVT's and PE's. Many labs, a CAT scan and thoughts of anti-coagulants later, they had pneumonia. Antibiotics and try to get out of bed every once in a while.
- COPD exacerbation: stop smoking when you're 20, seriously, I don't want to see you every week in the ED because you've been smoking for 40 years and are on home oxygen and your breathing is getting worse. I can't fix what's already broke. All I can do is a quick patch until the next time.
- medication refill: It must really suck to be 27 and have been in and out of the hospital since you were a teen. This patient already had a kidney transplant (which failed and they're back on dialysis) and bilateral (both-sided) hip replacements, one side with a revision. He has chronic pain. His doctor was out of town, and he's out of pain meds... supposedly, but hey, like the cancer patient, he'll pretty much get what ever he wants.
- possible medication ingestion: How a 2 year old can find his granddad's medication, open the bottles despite child-proofing and manage to pour all of the pills out onto the floor is the beginning of a near tragedy. Sis turned around "for just a second" and he managed to do all this. So, we watched him. Most of the medication might make him sleepy or sick to his stomach, and he was doing fine in the ED and didn't appear to have actually tried any of the pills, but still. You can't just send them home. They have to sit, for at least 6 hours.
and finally - anorexia: We joke about little old ladies and their tea and toast diets, but they get anemic. Then they get tired, and what little they used to eat they don't any more. Then they get more sick and tired and eat less, and you get where I'm going. Plus, I think there was an element of depression here. Husband died 2 years ago. Lives alone. I talked to her and her daughter about some possible solutions, so we'll see.
One more shift and then I have a day off... so it's off to bed for me. Until tomorrow.
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2 comments:
interesting day; I felt sorry for the mom with an ear infection and three young ones; all moved me in some way.
so if the attending had the paperwork ready does that mean he did the dictation? bet you got 'stuck' with it.
betty
Actually, it's a different system there... we (the residents) are "guests" with no real privileges, so when we write notes or give orders, everything is co-signed... almost like we aren't really there...
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