today was my last day. thank god.
spent some time in the ER [see previous post], admitted my old pt then admitted one more elder hispanic female with a UTI and PNA. i got a scare at around 6pm of potentially getting another admit [they usually take about 2 hours] but didnt end up having to do it so i left around 6:30, one of the earliest times i have left the hospital on a normal shift.
so thats it, IM is over and i got a pretty good evaluation from my intern. sad thing is, i am at this same hospital again on Monday but on the Psychiatry service so my hours will be waaaaaaay nicer. unfortunately, we have to do 2 IM calls during our Psych rotation so I will be doing IM admits again in the near future. actually, i just saw the schedule and found out i am on call overnight on Valentine's day. good thing i didnt have any plans...
Friday, February 10, 2012
ER, IVs, Needles
i've been hanging around the ER trolling around for things to do and have been asking nurses to watch and potentially do an IV. well, after watching some, I was finally able to get a nurse to offer to let me do it and talk me through it. Ironically enough, i ended up doing it on a very familiar patient.
it was the 30-something year old that I admitted about 2 weeks ago. the one that put himself into heart failure and had diabetic retinopathy from her uncontrolled diabetes [he cant see shit and he only has himself to blame.] granted, he is a really nice guy, just doesnt take care of himself at all. its very sad actually.
so i went in with the nurse when he initially was brought into a room and i asked him if i could start his IV. he had no problem as he remembered me from taking care of him before. I pretended to be confident and i did it, got a flush on my first attempt and put in the IV catheter. i think the nurse was pleasantly surprised i didnt miss or infiltrate the needle. i was proud of myself.
needless to say, i ended up admitting this pt to the floor again as his blood glucose was around 500 and he has PNA.
after hanging out in the ER some more, i buddied up with the intern and went in to see a 'finger pain' patient. this 24 year old, uncontrolled diabetic, had a fat swollen finger that looked infected for sure. we presented to the attending and learned a ton from him about finger anatomy and injuries. then watched him do a finger digital block on the patient who was terrified of needles. the attending handled it so well and was hilarious while doing it, such good bedside manner, something i hope to be exactly like. so he numbed up the finger with lidocaine, cut a big slice at the end of his finger and squeezed and drained everything out. the infection was to far under his nail so we had to remove it too release the pressure. so i watched him tear off a perfectly normal fingernail which actually takes a good amount of force. it was gross and cool at the same time.
it was the 30-something year old that I admitted about 2 weeks ago. the one that put himself into heart failure and had diabetic retinopathy from her uncontrolled diabetes [he cant see shit and he only has himself to blame.] granted, he is a really nice guy, just doesnt take care of himself at all. its very sad actually.
so i went in with the nurse when he initially was brought into a room and i asked him if i could start his IV. he had no problem as he remembered me from taking care of him before. I pretended to be confident and i did it, got a flush on my first attempt and put in the IV catheter. i think the nurse was pleasantly surprised i didnt miss or infiltrate the needle. i was proud of myself.
needless to say, i ended up admitting this pt to the floor again as his blood glucose was around 500 and he has PNA.
after hanging out in the ER some more, i buddied up with the intern and went in to see a 'finger pain' patient. this 24 year old, uncontrolled diabetic, had a fat swollen finger that looked infected for sure. we presented to the attending and learned a ton from him about finger anatomy and injuries. then watched him do a finger digital block on the patient who was terrified of needles. the attending handled it so well and was hilarious while doing it, such good bedside manner, something i hope to be exactly like. so he numbed up the finger with lidocaine, cut a big slice at the end of his finger and squeezed and drained everything out. the infection was to far under his nail so we had to remove it too release the pressure. so i watched him tear off a perfectly normal fingernail which actually takes a good amount of force. it was gross and cool at the same time.
Thursday, February 9, 2012
Wise words?
"Everyone gets sued, if your not sued that means your not seeing enough patients"
-during a lecture from Dr. A, a cardiologist
-during a lecture from Dr. A, a cardiologist
Monday, February 6, 2012
Central Lines continued!
i just watched Dr. S put in 2 more central lines and after the second one was done he nonchalantly said,"ok, you've seen 3 now with me so you can do the next one ok?" i was stunned and replied, "yeah, ok, no problem."
i tried to act cool but i was doing cartwheels inside. :)
i tried to act cool but i was doing cartwheels inside. :)
Friday, February 3, 2012
Central Lines
I love to watch procedures and try to get involved as much as possible. whenever i hear of something I asked the resident who is going to do it if i can help. this time, it was a third year resident who i have known since last year through Montclair clinic, Dr.S. I watched him put in the central line and it went flawlessly. he was very quick and impressive, nothing at all like watching the first year interns. it really does take lots of practice to perfect these things.
he asked me how much longer we had in the rotation and i told him another week. he then said, "ok, you should be able to do one before you leave." i was STOKED.
he asked me how much longer we had in the rotation and i told him another week. he then said, "ok, you should be able to do one before you leave." i was STOKED.
Thursday, February 2, 2012
ICU
we had a pt that was in the ICU this week. 40yo hispanic women who had breast cancer. she had treatment in Mexico along with a mastectomy but nothing helped, the cancer spread and when she got to us, she was on a respirator and not conscious. if you looked at her chest, her cancer had come out from her breast to her skin and was spreading all over her skin. it was a very sad sight. she had scar tissue from the surgery as well and the whole sight was very shocking.
i happened to be in the same area when the pulmonologist was reviewing her CXR and it was breathtaking. i had never seen such a dense x ray of consolidations. she explained that everything in her lungs was lymphatically spread cancer and that this women was going to die in a matter of hours or days.
her family was notified of all the findings and they decided to take her off the ventilator. there were 20-30 people in the ICU that day. they asked the family to leave and the nurses gave the patient morphine then took her off the ventilator. her vitals stayed up and the family was invited back into the room. about 3 hours later the patients stopped breathing on her own and died. i was not there at the time but did come back downstairs as the family was visiting and paying their respects. they stayed for a good amount of time after and then it was quite again in the ICU. she was only 40 years old.
i happened to be in the same area when the pulmonologist was reviewing her CXR and it was breathtaking. i had never seen such a dense x ray of consolidations. she explained that everything in her lungs was lymphatically spread cancer and that this women was going to die in a matter of hours or days.
her family was notified of all the findings and they decided to take her off the ventilator. there were 20-30 people in the ICU that day. they asked the family to leave and the nurses gave the patient morphine then took her off the ventilator. her vitals stayed up and the family was invited back into the room. about 3 hours later the patients stopped breathing on her own and died. i was not there at the time but did come back downstairs as the family was visiting and paying their respects. they stayed for a good amount of time after and then it was quite again in the ICU. she was only 40 years old.
Wednesday, February 1, 2012
nurses
i realize that nurses 'run' the hospital and that i should be really nice to them because they could make my life a lot harder. but some of them are really freaking mean.
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