And For My Next Trick...

Every once in a while I do a procedure in the emergency room that isn't done very often.  Every once in a while I do a procedure while there are nursing and paramedic students around.  And, every once in a while I do a procedure that isn't done very often while there are students around.  Like today.  Today I drained a knee.

Now, we do knee "taps" not infrequently in the emergency department, but it's unusual to do one on a pedi.  That's pronounced pee-dee... as in pee-dee-atric patient.  Not peh-dee as in peh-dee-cure.  Anyway, we get sick pedis every once in a while, and tonight I got a small patient with a big knee that needed to be tapped.  And, I had a nursing trainee and a paramedic student en tow.  Throw in mom and little sister, and I had quite the audience.

I don't mind performing under pressure.  Heck, I'm an E.D. doc, and I do it all the time.  Add an audience, and it just adds to the fun.  I remember as a surgical resident sitting in report looking at chest films and hearing the intern say that one of the patients was suddenly short of breath and with a fast heart rate.  He thought he might just be in pain.  I took a look at the chest x-ray and quickly realized the patient had a collapsed lung and might be developing a potentially lethal complication called a tension pneumothorax.

I called out my suspician to the trauma team, and we rushed out of our conference room en masse to the patient's bedside.  I had my senior resident, the attending and about 3 interns plus several medical students all rushing around gathering supplies.  I was given the job to put in the chest tube since I was the junior resident and responsible for this.  Now that was pressure.

Tonight, not so much... but still, you have to get used to working under a spotlight sometimes.