Frequently patients present to the Emergency Department for lacerations, partial amputations, and abscesses of the fingers. After repairing the wound or injury, however, a bandage can be a bit unwieldy to apply and difficult to secure. To me, an ugly bandage just seems to detract from all of the diligent work that you just put into a plastic surgeon-quality wound repair.
Practicing at an academic ED, such as in San Francisco General, I find that I am constantly surrounded by medical students, interns, and residents. Most are working on shift with me, but occasionally I have medical students shadowing me to learn more about the Emergency Medicine specialty.
Have you ever had a person shadow you (excluding your annoying little brother when you were a kid)? It’s actually a little stressful for me, because I want the shift to be a positive learning experience for them. Inevitably, it doesn’t take long before I get immersed in mundane troubleshooting activities (eg. calling to transfer a patient to another facility, coordinating the CT scan priority list, paging the inpatient team for admitting orders).
As a medical student, do you remember your EM clerkship experience and whether you saw a wide variety of patient chief complaints? Did your fellow medical student on the EM clerkship rotation, who was going into Orthopedics, seem to only see patients with orthopedic complaints?
If a journal gets accepted it into the Medline database, it is viewed with significantly more legitimacy. It follows then that your academic CV is better regarded if your publications appear in journals which are listed on Medline. Plus, it’s just fun to see your name listed in Pubmed when you search yourself! Hmm, that sounded more egotistical than I intended, especially since I don’t have that many publications on Medline…
Nothing frustrates me more than not being able to obtain intravenous access in hemodynamically unstable patients, especially because I give a talk on “Troubleshooting the Difficult Vascular Access Patient.”
What would you do in this trauma case?
Recently on my ED shifts, there were several especially challenging endotracheal intubation scenarios.
- A patient with thick frothy sputum constantly oozing out her trachea such that we couldn’t see the vocal cords– no matter how much suction we used. Imagine the Diet Coke and Mentos backyard experiment. I’m not kidding.
- A 300+ pound agitated trauma patient with almost no neck, who eventually was found to have an epidural and subdural hemorrhage.
- A COPD patient who was increasingly lethargic, hypoxic, and hypercarbic (pCO2>115), who I knew would start desaturating quickly as soon as rapid-sequence induction drugs were given.