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.

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.