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.

7. DVT

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.

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on April 21, 2012, in Clinical skills, Emergency Medicine. Bookmark the permalink. 10 Comments.

  1. What caused the big ball syndrome?

  2. Apart from those ,see anything interesting last night?

  3. Touche.

  4. I’ve found that 2 OPAs and 4×4 gauze stuffed into the cheeks can help when folks don’t have teeth! Add some NPAs too.

  5. We had a junkie woman the other night who’d burned out all her dopamine receptors from years of abuse. While waiting for a bed in the ER she would repeatedly masturbate rather roughly in full view of the rest of the ER. When we tried to pull the blinds she screamed until we opened them again, so everyone got a free show with their ER visit.

  6. Hands down?

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