END OF FIRST ROTATION - Emerge

The first rotation was a big leap. It felt like I dove into the deep end and had to either sink or swim. There were moments of splashing about and close calls. Overall I think I still have my head or at least my nose above water managing to breathe. Here are a few things that I was able to do, see and diagnose. 

PROCEDURES

• Sutured including injecting local anesthetic – sutured a few times on the fingers and the face :S It went well :)

• Observed incision and drainage of an abscess

• Observed code blues – including CPR and epinephrine administration

• Observed cardioversion – when a shock is given to a patient with fast arrhythmia of the heart in atrial fib/flutter and ventricular tachycardia. 

• Observed thoracentesis – removing fluid in the lung

• Observed lumbar puncture – collecting spinal fluid from the spine

• Assisted in intubation – the doctor inserted a guide wire with the laryngoscope and I inserted the endotracheal tube. Also used a bag-valve-mask to help with a patients breathing.

• Observed a central line being inserted 

• Assisted in reductions of different broken or dislocated bones such as the shoulder and wrist  with conscious sedation and assisted in casting

• Assisted in removal of a foreign body in the ear

• Observed packing of epistaxis (nosebleed) 
  
  

DIAGNOSIS I SAW/DIAGNOSED


Diverticulitis

Radiculopathy
Pulmonary Embolism
Hernia
Prostatitis

Fractures – Coles, ankle, hip, hand

Lacerations – fingers, chin, eyebrow

Seizures

Chicken pox

Kidney Stones

UTI

Mono

Strep throat

Vertigo

Muscle strain

Impetigo

Eye ulcer

MI (myocardial infarction – heart attack)

TIA (transient ischemic attack – “mini strokes”)

COMMON COMPLAINTS

Abdominal pain

Back pain

Sore throat

Chest pain

Shortness of Breath

General weakness

Minor complaints-       unspecified

There are more things I’ve seen and done but these are the first things that come to mind. I did take a picture of my first prescription for diverticulitis. I just wrote down what the doctor told me to :) 

My First time writing a prescription dictated from the doctor :P

  

Last shift in emerge is on Tuesday then off to our first academic day. My next rotation in Orthopedics starts on Thursday!

ROTATION #1 - EMERGENCY

Having had been in school 4 days in a row before our first day of rotations was exhausting, exciting and overwhelming. We were given our pager, we were told how we were to be evaluated for our rotations, we had training sessions for the different computer programs we will be using this year and we were told to start thinking about our Capstone project. :S

MY FIRST DAY OF MY FIRST ROTATION 

The first day jitters was rough. I was nervous and could not sleep that well the night before but I was prepared. I had my books packed up (our class had a “freak out” bookstore shopping spree during the week :P) I had my clothes picked out, ironed and white jacket ready.

6:00 am: Woke up in a panic and began making breakfast and getting ready

7:00 am: Drove to Emerge

7:20 am: Sat in the parking lot thinking it didn’t take as long as I thought and I don’t start till 8:00

7:30 am: Sat in the physician lounge and looked around. I asked a nurse who I was there for and they said doctors don’t come until 8 am.

8:00 am: My preceptor came in and we talked about what I expected from the rotation

Right away I was told to see a patient. I was nervous but you just “have to do it”. I took a history and physical then reported to my preceptor and discussed what investigations I wanted and my differentials. This occurs daily. The first day was exhausting, exhilarating and fun. You realise how much you know but also realize there is so much more you don’t know.

EMERGE

How it is set up in emergency is the patients are triaged (ranked based on severity) for you by the nurses in the front. The nurses take the first history, physical and vitals.  The patient’s charts are then placed on the desk in emerge and these are patients who are waiting to be seen. You grab a chart take a history and physical on that patient, talk to your preceptor then order your investigations. While waiting for results you either see another patient or observe a procedure/emergency such as conscious sedation for reductions (setting the bone to its original position in a fracture) or cardioversion (when you shock someone who has a funky heart rhythm). When results come in you determine what to do next or how to treat while consulting with your preceptor. I was surprised how calm it is in emergency. The doctors are relaxed, laid back and are great educators. Your preceptor changes each shift so at the start of each day there is a bit of anxiety. You do work with some of your preceptors more than once. 

As much as I have been learning about how to take efficient histories and seeing different ailments the one thing that I’ve been learning a lot about are the different health care roles in emerge. There are so much more than doctors and nurses. Nurses can do so much more than I knew.   Medicine is a team effort including pharmacists, health care aids, technicians, respiratory therapists, social workers and so much more.

CLASS OF 2013 GRADUATION

Congrats to the class of 2013 for making it through the PA program! :P  The dinner was great with fabulous speeches and lots of celebration fun :)