ER.

Today I shadowed the attending ER physician, Dr. B. The morning was quite slow; we only saw two or three patients, none of which were particularly interesting - colds, flu, etc. Consequently, I spent most of the time catching up on my reading in the break room.

The afternoon began slowly but things picked up by 2 pm. By 3 pm it was getting a little nuts; the ambulance crews just kept coming in with new patients, and triaged patients were starting to stack up on the extra beds in the hallway.

At about 3:30, an elderly woman with severe lung disease was brought in by ambulance. Dr. B and the other physician went into the room to take a look, and when Dr. B came out, he simply pointed at me and said, "Go." I went.

It was exactly, EXACTLY like a TV show: ten, maybe 12 people all crowded around the bed, running around, shouting orders. The patient was extremely obese and completely naked on the table, clearly unconscious. The nurses were trying to get an IV started but they had difficulty finding the appropriate blood vessel. The woman's airway was partially obstructed so the docs were simultaneously having difficulty getting the breathing tube in. To keep her breathing, they injected some drugs, but I didn't catch all the drug names. They finally intubated her and her pulse ox stats immediately went from the low 60s to the high 80s, and her heart rate jumped from about 35 bpm to about 90. The patient was still in critical condition but she was stable, so they brought in the x-ray people to make sure the breathing tube was properly placed.

Respiratory therapy was called to connect the patient to the ventilator. Before hooking her up, the respiratory therapist suctioned up a quantity of what they told me was probably a large pulmonary edema. Finally, the ER doc drew about 25 cc of blood from the femoral artery (with two nurses retracting the patient's enormous abdomen), and the resident started an arterial line in the patient's arm, which spurted blood all over the table before he got it in properly. The room cleared a bit as some of the nurses left, but not before Dr. B peeked in and said to me, "Now that's some serious medicine!" I had to agree. It was pretty intense.

There are two major morals to this story:
1) Don't smoke.
2) Don't be fat.

The last I heard, the resident was trying to get the patient admitted, but the pulmonary service didn't want her, so he was trying to convince cardiology to her on. I'm not sure what happened.

So...I survived my first real trauma. It was terribly exciting, but after that patient I was tired and left for the day. I was pretty much just in the way the entire time anyway, so I figured the staff wouldn't notice my absence.