Tuesday, July 28, 2009


This is one of my favorite televisions shows. This is also my constant emotion these days. I haven't felt so, well, LOST since the beginning of medical school where I was convinced that everyone was constantly studying and I was incisively behind. I eventually just did stuff on my own pace and my own way and things went fine.

But doing things my own didn't really affect anyone else. My actions did not influence patient care. Now I can't really hold off on reading that chapter on hyperbilirubinemia because that kiddo is in the ED NOW.

I know I don't need to and can't possibly know all the answers now (why would I be doing residency if i did??), but I feel like I've got nothing in terms of knowledge. I am just roaming the island trying to figure out how to get back to what I know.

Friday, July 17, 2009

Did you goose it???*

The first trauma red came in around 1030 am yesterday. Being an intern and not having done trauma or ATLS (adv. trauma life support) it means I cannot sign up for the trauma patient. But it being 1030 in the morning, and nothing else to do, I asked my third year resident if I could tag along.

The pt was running from the police, up a hill, and fell, severely dislocating his right knee. After a few xrays and a quick physical exam, the residents and attendings quickly realized that the leg was pulseless below the knee and that compartment syndrome was setting in...and fast.

It felt almost like a Greys Anatomy episode (except no one was sleeping together)-- the decision was made to intubate in the ED and I quickly jumped in and asked my third year if I could do it. He paused for about fifteen seconds. When he finally said yes, I did a double take--wait did I really want to try this?

I got my stuff all set up. And we discussed which drugs we were gonna use. My attending pushed the drugs and said, "Ok, you ready?" I had a quick "OH MY GOD YOU ARE NOT READY!!" But I picked up the laryngoscope and started opening the mouth. The patient was in C-spine so I couldn't open the mouth too widely for fear of hurting his possibly fractured neck. I used a CMAC (we have an awesome airway man attending who tries out all the new airway stuff before it even goes to other hospitals)--it is a video laryngoscope but allows the intubator to also use it as direct, meaning you look into the patients mouth while intubating, and not at the video screen. Which is what I did---I didn't even realize it was video until my attending said "Go in a bit deeper."

I wasn't used to seeing the mouth with saliva. I was used to the plastic dummys so when I saw all the bubbles, I quickly yelled "I need suction!" but then I got a glimpse of the vocal cords (hahahaha! see previous blog) I yelled "Need the tube!" and I quickly jammed that thing down there. Then I reminded myself DO NOT LET GO OF THE TUBE. We use a color indicator to help us make sure we are in the correct spot (if the color looks like urine, then "ur in!") The stress and excitement quickly came rushing at me and I had some uncontrollable shaking. I left the trauma bay to try and pick up where I left off with my other 3 patients.

I was on a high the entire shift.

*Apparently this means did you stick the tube down the esophagus into the stomach. I of course screamed a yes! when asked this the first time. I quickly realized this is not a good thing. and luckily I did not do this.