A different sort of high for 4-20
Yesterday was probably the best shift of PGY1 year so far. A steady, but not overwhelming flow of patients, and not a single one there for B.S. reasons or drug seeking. Lots of cool things and procedures throughout the night. Patients, in order of appearance.
1. First time allergic reaction with difficulty breathing
2. Police Officer bit in the hand, who then got it drenched in the prisoner’s blood.
3. Status Epilepticus that needed to be intubated
4. Debilitating headache for 3 weeks with syncope
5. Septic Shock
6. Noxious gas exposure at chemical plant x 2 patients. Vomitting, sweating, headache. Had to open up the decon room for these guys.
8. Chest Pain
9. Massive testicular swelling
10. Painful supra-clavicular nodule with arm numbness
11. Drunk college student – who insisted on repeatedly flashing her breasts every time I walked by.
12. Drunk teenager – Parents out of town. Not pleased to get my call interrupting their Caribbean vacation.
What helped make it so great, I knew what to do for all my patients in both a big picture sort of way and also in most of the details, and only needed a tiny bit of input from attendings on a few minor points (IV vs Sub Q Epi for the allergic reaction for example). The toughest thing during the whole night was trying to get a good seal using the bag valve mask on this guy who had no teeth. Seriously, if you have never tried it, DON’T try it alone, get someone to help you, it definitely works better with an extra set of hands.