Shadowing – ER edition

As I take a break from scratching my head over physiology, I thought I might recap what happened while shadowing in the ER this morning. For one, although it is only a Saturday morning in a quite, suburban town, I was surprised at the contrast of the ER-in-my-head with the ER-in-real-life. My vision of an ER is people running around and calling out vitals etc. to each other, papers being hastily shoved from one person to the next, and constant beeping with alarm noises going off every few minutes. Not so this morning. It was so calm! Nurses milled around (I even chatted with someone I knew from highschool!) and most of the rooms were empty.

When the doctor we shadowed (referred to as “Dr.” from now on) came in, we began right away. Dr. followed up on cases from the last shift and asked about a Jefferson fracture (which I had remembered studying, but couldn’t quite recall details…). Then Dr.  let us take a brief history for a patient, asked us to examine a patient with suspected bowel obstruction, and showed us 2 pelvic exams. We saw a severely malnourished patient at the end stages of COPD, listened to wheezes on another COPD/asthma patient and then witnessed someone rushed in with a subdural hematoma. For a “quiet” Saturday morning, I felt as if I saw a lot! I can’t imagine juggling even more patients on a busy night. Also, will this feeling of not knowing anything ever go away? I mistook a liver for a heart on a radiograph – surely this was the one question I should not have missed. Ah well, kick myself and don’t make that mistake again.

Just for fun, some new words: mirena, wells’ criteria, external os (of cervix), sinus tachycardia, afib

Emergency medicine seems almost like a game – you’re constantly juggling tests and patients and nurses and meds. How do ER docs keep all the patients straight?! It’s interesting in that you never know what you’re going to get, and so all of your training is used – radiographs, EKGs, physical exams (cardio, neuro, HEENT, etc), pharmacology, and on. One downside is that you never get to really know your patients. There’s too little time, and follow up will probably be done by primary care physicians. I guess the upside to this is that you never get attached to any of the patients – but I wonder if this affects your ability to see them as people rather than just as patients/diseases/cases.

Overall, this was an exciting morning, and I definitely hope to go back in and get used to a doctor quizzing me on things I should know.

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