Wednesday, August 1, 2012

Week 10: Wrapping Up

This is a delayed post, but I have been really busy for the past two weeks. My internship officially ended one week ago, Tuesday July 24th, with a dinner for all of the Emergency Department members who a involved in research. Dr. Paz, the Dean of the College of Medicine and CEO of the Medical Center opened the dinner with a few remarks about the importance of research in Emergency Medicine.  There has not been much research done in Emergency Medicine, and Dr. Terndrup is one of the world leaders. After an Indian dinner, we heard from Dr. Lubin, the head of LifeLion, and two other attendings who are active researchers.  We also spoke briefly about our projects, and it was nice to see many of the students in my program last year return for the dinner.

My last week was very exciting though. We wrapped up our project for now by reaching our goal of retesting 52 residents, nurses and EMTs this summer. Peter, the medical student who I am working with on this project, will retest the medical students in September once everybody is on campus and a year has passed since their first testing. At that point he and I will collaborate on the statistics and paper writing. Hopefully we will have a paper to submit for publishing before winter break.

My last shift shadowing in the Emergency Department was my best. I worked with great residents and medical students, and they were really good about teaching me as much as they could. I saw several interesting patients, and I hope that I am never considered an 'interesting patient'.

The last two Tuesday morning resident lectures were some of the best too. We learned how to suture using pig feet during the lecture, and I later rotated through several stations in the simulation center, each of which focused on some aspect of airway management. I learned to intubate with a Miller glide scope, and was taught to insert a breathing tube. These rotations were for the first year residents and fourth year medical students, but they included me just like I was one of them. On my last day of work, this past Tuesday, I participated in a simulation for the residents. My job was to act like a nurse who needed an EKG read at that moment. I had to see if the resident would ask me to wait or read the EKG, and if they read it correctly. This was all done in the simulation center, and the resident directors were able to observe everything from behind one-way windows. It was a really cool exercise, and the residents were obviously flustered by the end of it. After the debrief at the end though, it was evident they learned a lot.

I had a fantastic summer internship with the Emergency Department. I really appreciate Dr. Terndrup allowing a JC student in the program each year. I also want to thank Nancy Campbell, the nurse in charge of ED research, and both of the ED secretaries. I'm grateful for the guidance the residents and other medical students have given me, and I wouldn't have gotten as much out of my experience had it not been for all these people. While I realized I want my patients to be my focus instead of research, it was a great opportunity to do human subject research in the hospital. Hopefully my project can be used to better train hospital employees in CPR, with the end goal of saving more lives.

Thursday, July 12, 2012

Week 9: Stay Away From Chainsaws

While the week isn't over yet, I had my weekly shift shadowing in the emergency department today, and to say the least it was interesting. There was not a single trauma, which was weird, but it was very busy all day. To make matters worse, there were were very few available beds in other hospital departments, and that prohibited us from transferring stable patients to other departments. As the day progressed, the patients kept coming in and beds continued to fill. At one point there were patients in the overflow hallway beds, but that isn't uncommon. By the end of my shift things had calmed down a little as they usually do during the late afternoon, just in time to ramp back up again after 6:00 or 7:00 PM until the early hours of the morning.

One of the patients I saw today was in severe respiratory distress and was intubated. I got to observe the procedure, which was interesting since one of the studies I am working on deals with developing an evaluative scale for intubations. Another patient had a severe headache after a lumbar puncture spinal tap. The headache is caused by a slight leakage of cerebral spinal fluid through the small hole made by the injection. This is not uncommon, and if the recommended treatment of drinking lots of caffeinated beverages doesn't work, the treatment is a second lumbar puncture in which patient's blood is injected.  The patient's blood clots and plugs the hole naturally. I've been impressed with how well the residents I shadow educate their patients. Not only do I learn more, but the patients seem much more satisfied with their experience.

Although I saw an array of patients today, the one that really stuck out to me was my last patient. I spent the final hour and a half of my shift assisting a resident while she closed a chainsaw injury over a patient's knee. It looked horrendous, but the patient was extremely lucky. While you could see the muscle and bone, the chainsaw did not injure the muscles, bones, tendons or ligaments. It was entirely superficial. After suturing the wound internally with dissolvable stitches, the resident began closing the wound with sutures. After placing only two, however, she removed them and resorted to staples. I then watched her staple the wound close. During most of this, I talked with the patient to keep him occupied. While his children did not attend Juniata, it turns out he has been to Juniata's campus several times to attend his children's sporting events. He is also familiar with the Church of the Brethren and the Huntingdon area. Small world.

Earlier in the week I spent a lot of time trying to find the people we still need for our study who have fallen through the cracks. My schedule has been sporadic, but things are coming along well. We only need about 6 more emergency department employees plus several EMTs we hope to get next week.

On Tuesday I attended Grand Rounds for the Emergency Department residents again. They are really informative, and this week I also attended a lecture for the fourth year medical students who are just beginning their emergency department rotation. I learned about the source of many types of chest pain and how to treat them. I also heard several pediatric trauma case presentations which were very interesting.

I can't believe I only have eight more days of work with the Emergency Depcartment at Hershey. I've really enjoyed my internship and am really thankful to Dr. Terndrup, Nancy Campbell, the Emergency Department physicians, residents and nurses I have worked with,  and the other medical students in my program. It's been a great experience.

Saturday, July 7, 2012

Week 8: More Testing and Driving Improvements

My schedule this week was very sporadic. We are at the point in the study now that we have to come in at weird hours to catch the people who do not work regular shifts. Being in the Emergency Department, you never know when it will be busy and when it won't be, and this week has been busy. The Fourth of July is the deadliest day on American roads, and although I had off on Wednesday, the Emergency department was still very busy on Thursday morning when I arrived.

Most days this week I have had to come in very early to catch people on the night shift. There is normally a lull in the action between 4:00 and 6:00 once all of the late night traumas end and before most people wake up in the morning and realize they need to go to the hospital. So, I have been here most days around 4:00. Thankfully I'm not working on this project alone, and Peter and I have been able to split the really early or really late shifts. It is now Saturday though, and I'm writing this with Starbucks sitting next to me after getting here at 4:00 this morning too.

All the early mornings have really paid off though. We have now tested about 40 people, and I hope to test another five before I leave today. On Tuesday I spent the morning with the new third year residents during Grand Rounds, and learned how to interpret difficult EKGs and heard an interesting presentation about traumatic eye injuries. Before, between and after presentations Peter and I were able to test the residents who participated in this study last year, and we tested 8 people in one day.

I mentioned in last week's post about how people stare at the mannequin that we use for CPR testing as we are pushing it down to the Emergency Department from the Simulation Center. Well, the stares haven't stopped, but my ability to drive the beds has improved. On the bed we use to transport the mannequin, there are three options: Brake, Neutral and Steer. The steer option doesn't always work on our bed, which was the cause of my bad driving. I almost have to stand on the pedal for it to stay down,  but it is so much easier to drive when it is steering correctly. I also don't get threatening looks anymore from other people as I struggle to push what looks like a patient down the hall way.

Friday, June 29, 2012

Week 7: Emergency Department Shadowing and Chest Compression Testing

This week flew by.  It started at 7:00 AM on Monday morning by testing several participants in the chest compression study. We have been bringing a mannequin down to the Emergency Department from the Simulation Center to make it easier on the participants, and every time we bring the mannequin through the halls, people think it is a dead person if we keep it covered. If we leave it  uncovered, people wonder why the person is so pale.  These mannequins aren't the kind you would have used in the past for CPR training. The one we use costs about $80,000 and has an array of capabilities. It is hooked up to a computer, and on command it can have a heart attack, get sick, make different sounds, change the size of its pupils, and many more features. They are normally used for training for the residents, doctors and hospital employees so they have practice before doing a procedure on a real person.  We are using this type of mannequin because it has an internal sensor that monitors chest compression depth, chest recoil, hand placement, and compression rate.

Anyways, our main goal for this week was to test as many Emergency Department nurses and EMTs as possible, so we have been coming in at various times to test as many people as possible. The earliest day was at 5:30 AM, but most days we went in around 7:00.  We have now tested 25 people, and we need at least 100. This coming tuesday we will be testing the residents, which will hopefully give us another 10 people, and we will be tracking down people who now work in other departments this coming week. We will also be testing the weekend crew tomorrow morning beginning at 4:30, but the med student I am working with is covering that shift since I am going to the beach for the day. Thank you Peter!

On Tuesday I had my first evening shift in the Emergency Department, and it seemed completely different than the morning.  On Tuesday mornings all of the residents are at Grand Rounds so the PAs cover their shifts, and Tuesday evening was busy.  I followed a resident who was just finishing her first year, and I saw many interesting patients.  I don't get grossed out by blood, but I have found that the self-inflicted traumas do bother me.  We saw 8 traumas from 6-11, and it was a busy night. I wish I could say more about the patients I saw, but because of patient confidentiality I can't. I am really enjoying the time I spend shadowing in the ED.

Monday, June 25, 2012

Week 6: Mesh Terms and MCAT

This past week was busy since I had my MCAT on Thursday. On Monday we worked with the reference librarian to finish out literature search for the intubation study. Peter and I were convinced that we had found everything pertaining to the airway study, but after spending almost two hours with the reference librarian, we learned otherwise. She was a pro at mesh searches! We only found 3 papers that had anything related to our project, but these three papers were very helpful. The librarian turned out to be a Juniata graduate too, which was a cool connection. We also made a few graphics for each study to better explain the experimental design for the next meeting with Dr. Terndrup and the other research students.

On Tuesday we spent the morning with the residents in grand rounds. The were being tested, so I rotated with them through three stations. I watched them read EKGs and ultrasounds, identify eye problems, and I did chest compressions on a mannequin for a resident during a cardiac arrest simulation. I also sat in on the M&M meeting that addresses cases in which a resident could have treated a patient differently for a better outcome. We then made sure everything was ready to begin taking the mannequins from the simulation lab down to the Emergency Department before going home for the day.

On Wednesday we went in at 7:00 to test people's chest compressions in the emergency department. We got 4 people on the first day, which doubled our participants so far. I was supposed to have off today, so I left around 10:00 to go drive to the testing center and prepare for my exam.

On Thursday I had my MCAT, and I was in the Emergency Department on Friday. I saw some pretty interesting patients and got to stand in on some traumas. I'm grateful for the residents who let me follow them around, and I learned quite a bit through their teaching. Next week we will be testing people each morning starting at 7:00 AM.

Friday, June 15, 2012

Week 5: Emergency Department Shadowing and Subject Testing

This week began on Monday in a meeting with a biostatistics professor who is doing the statistical analysis on the airway study I am helping with. The first objective of this study is to determine a scale to accurately measure a person's ability to do a rapid-sequence intubation outside of the hospital. There is currently no scale for this, and current research debates whether or not prehospital endotrachael intubation should be done by EMTs at all. Developing a scale to determine whether or not EMTs can successfully intubate a patient without doing more harm than good will be important to answer whether nor not EMTs should be intubating patients.

Developing this scale, however, is going to be a lot more difficult than I expected. We need to look at variable strength and assessment tool strength. For example, should a question be a simple YES or NO answer, or should it be a proficiency scale. If we choose a scale, should that scale range from 0 to 5 points, 0 to 10 points, -5 to +5 points, etc. Should certain variables be weighted more than others? The power analysis of each question goes beyond my statistics education. Thankfully that's why Dr. Yang is involved.

On Tuesday I spent the day in the Emergency Department observing and screening for patients who could be eligible for the national emergency medicine studies in which Penn State Hershey is participating. While none of the admitted patients qualified from my 7-3 shift, I did see several interesting trauma cases. I couldn't help but make MCAT questions in my head about the cases I was seeing.... "If drug A increases a patient's blood pressure, which hormone is most likely released and from what gland?"

I finally met with Human Resources yesterday, so hopefully I'll get my first paycheck soon. I'm learning that there are definite advantages of being part of such a large institution, but everything takes so much longer to accomplish...

This afternoon the other research students and I have a meeting with Dr. Terndrup to present our progress. Hopefully he is impressed with what we have accomplished so far. As of today I am half done with my internship. The time is flying!

Monday, June 11, 2012

Week 4: Progress

After having to wait for Institutional Review Board approval for 3 weeks, everything started progressing quickly last week. We got IRB approval on Monday, which means that we could begin testing our participants. I still didn't have access to the database we are using, however, but that came on Tuesday. On Wednesday we tested our first participant for the chest compression study. Although we still have about 100 more, it was good to start testing. Unfortunately, the number of people who signed up after we sent an email was really low.... We are looking at bringing a mannequin and laptop down to the emergency department to test our participants, who are all ED employees, in an empty room when they have time. 

I finally got my employee badge on Thursday after 4 weeks of work!

We also began designing the database for the second study we are working in.  This three-year study will begin in July, and our job is to design the data collection tool for it. We designed a preliminary version from Wednesday to Friday, and we have a meeting today (Monday) with a biostatistics professor who is one of the project investigators. Hopefully he likes what we have done!

Last Tuesday we got another tour of the emergency department and an orientation to our job in the trauma bay for the next 6 weeks. We will be taking shifts from 7-3 or 3-11 to troll for newly admitted patients who may qualify for the national studies that Penn State Hershey is participating in. I'm excited for this new task because it will mean spending less time in the library and more time in patient areas. My first shift is tomorrow morning, and i'm looking forward to it.