Hi friends,
Well, this first week in the ER sure has been eye opening. I have seen more chest pain and shortness of breath than I could imagine, and more drunks than my whole four years at IU....ok, I'm exaggerating that last part.
Also, pink eye is running rampant through Lexington this week so don't go rubbing your eyes in or on anything suspicious...or if you do, don't say I didn't warn ya.
I have seen so many different things this week and learned so much. First of all, the staff at Good Sam UK are so great. It is such a cozy little ER and everyone is so friendly. They bought me dinner the other night for going to get food for them, that was so nice. Anyways, I didn't exactly know what to write about since you get new patients all the time and the severity of the patients ranges from "my toe hurts" to actually having a heart attack to a drunk man singing amazing grace so I am just going to list my Top 5 cases that were either the most interesting/confusing/entertaining etc.
1. Amazing Grace: This man came rolling in on a stretcher and I honestly thought he was mentally handicapped. Then he starts belting out Amazing Grace at the top of his lungs which he later switched to 50s show tunes. You guys, the man could sure carry a tune for blowing a 0.47!!! Are you kidding me? He was too drunk to properly blow, but that was his initial reading and that's what they went with. He had no idea,who he was, where he was, or that his pinky toe was hanging off. Shout out to my girl Brittany who sewed it back on after I left. Also, he asked me to watch him pee, and asked the PA on duty for some heroin. Bold move, sir. Needless to say I'm sure he provided great entertainment for everyone last night.
2. Superior Mesenteric Artery Syndrome: I have never heard of this, so when I looked it up I was very intrigued. Apparently, the SMA comes off the aorta at around a 30 degree angle, but in those who have this syndrome, the angle of the artery is much smaller and compresses the duodenum causing excruciating pain. This poor 20yo girl came in screaming and writhing in pain all while vomiting uncontrollably. Essentially the artery mechanically obstructs the duodenum which leads to the vomiting. She wakes up like this pretty frequently and has been seen in the ER A LOT. All anyone can really do is control her pain and vomiting, GI has suggested she go to Mayo clinic because this problem is so rare and the surgery to correct it has an extremely high mortality rate. Once she had IV pain medication and zofran she was a new person, I didn't even recognize her. I just hope she gets the help she needs from physicians who are more familiar with this condition.
3.I'm Pregnant, want to tested for cancer, and also need some lunch: Okay, this is one of the HUGE problems of the ER, especially those like Good Sam. I'm not saying that homeless people don't deserve health care, of course they do, but what they don't deserve, or anyone deserves for that matter is an all inclusive stay in ER. This girl, who happens to be homeless, has a chronic cough. But also thinks she could be PG. So we do a urine PG test and the specific gravity of her urine was too low so we needed to do a blood test. She doesn't like needles, so she wants an ULTRASOUND!!!. No way, honey. Talk about healthcare spending. Then, gets off the phone with her dad and says, "my dad wants you to order a test to check me for cancer." I just simply told her there is no test for that. She already had a chest X-ray. We gave her some antibiotics because she did have a nasty cough and it had gotten worse over the last week, but says she can't get a ride to meijer to get it for free and can't afford the $4 at Walmart. It is terribly sad that she is in that situation, but what else could we do ya know? Then said she was starving and wanted to order a lunch tray before she left which of course she got.....just kind of hard to wrap your head around. She was on her CELL PHONE the whole time.
4. The atypical presentation: Teaching moment!! So, we have all been told time after time that not everyone presents in a textbook way. But the first time you really see it, it sticks with you. This lady came in with a chief complaint of "pain all over my body." I walk in and she won't really even talk to me which was very frustrating because I could not figure out what was going on with her or where she was hurting. I put my hand on her leg and she said don't touch me, so obviously the exam was difficult. She kept telling me the inside of her mouth hurt, her neck, her ears, her arms, and everything was burning, steaming, and on fire. She has a very complicated past medical hx, recent pneumonia with steroids so her blood sugars were out of control and to me her pain sounded neuropathic. The only information I could get was from her husband. I had no idea what was going on so I got my preceptor who then gets the attending and eventually narrow down that she is having chest pain and her ECG showed slight ST elevation in lateral leads and she was sent emergently to the UK cath lab. In hind sight, I should have realized her "mouth pain" may have been radiating pain to the jaw, but at the time I had no inclination that she was having a heart attack. It was a humbling experience and a very good teaching moment for me and for everyone really. I keep thinking about her and wonder how shes doing now.
5. The world's biggest pleural effusion: My friend and I watched this man get about 1800cc of fluid drawn out of his pleural space. It looked like apple juice, which apparently is a good thing. I don't know how he could breathe at all with all the fluid in there, what a trooper.
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