Friday, November 28, 2014

Day 28 - Semi-Live Feed

I thought I would try an experiment today and put in events as they happen during my shift in the ED.  I don't have Twitter so I can't "live feed," but we'll see how this works out, so keep checking back as I will update this post as the day goes along and time permits.

0500 - Came on shift to get sign-out of 14 patient waiting for admission, discharge or consultants to see them.  This didn't include the 3 people who were on psych hold awaiting placement at local psych facilities.

0503 - The first ambulance of my day arrives bringing in someone with a "numb arm" because they fell asleep on it.  I send them to the lobby to await fast track.

0510 - Ambulance (AMB) - "my shoulder and hip hurt"

0530 - reviewed a chest x-ray (CXR) and diagnosed pneumonia in a toddler

0545 - picked up a patient that was triaged earlier with abdominal pain

0550 - AMB - spouse called because patient "didn't want to wake up."  Patient admits to "drinking a lot of alcohol last night."

0555 - AMB - elderly patient with shortness of breath

0630 - patient with shortness of breath has a large fluid collection on their lung, call for drainage; another patient from sign-out has a dislocated shoulder and the orthopedist asks for me to do procedural sedation so that it can be reduced - after a lot of propofol (aka milk of amnesia) the joint is put back in place and discharge orders are written; another psych patient has forms to be signed so that they can be transferred

0700 - getting busy; two car crash victims come in for evaluation; taking care of more of the sign-outs and getting them admitted/discharged/sent to psych, etc

0800 - AMB - "I'm dizzy and haven't been taking any of my medication"
         - AMB - "My heart is skipping beats, and I think my potassium is low"
         - AMB - "My finger is infected, I've had diarrhea and stomach cramps, I haven't picked up any of the medications I was prescribed for infection 2 days ago."
         - AMB - Assault
         - AMB - Psych nursing home patient with abnormal labs.

0830 - I got coffee on the way in... yeah, Dutch Brothers!... I just finally got breakfast... what I really needed was a Snickers bar since I was turning into quite the Diva
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0900 - all Hell's broken loose... about 5 ambulances in a row and the psych patients are starting to get restless...

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1000 - trying to clean up from the pile of EKG's and CT scan results that are inundating my work space... did I mention about 4 more ambulances arrived?

1015 - baby bell went off... another life comes into the world

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1100 - AMB - "My chest hurts and my esphophagus is in spasm."
         - AMB - "My back hurts because I was sitting at dinner and then coughed."
         - a "drunken bitch" that was a signout from overnight has finally sobered up enough to state that she doesn't remember what happened last night and wants to know why her ankle hurts so bad.  What she doesn't remember is stripping off all of her clothes and running naked down the middle of the street.  Happy Thanksgiving...!
        - AMB - "I've had the flu and my back hurts.  Oh, and I had neck pain with a fever..."
        - AMB - "I got a flu shot and now I think I have pneumonia"
        - AMB - Patient sent from nursing home with concern for weakness and they "need a feeding tube."
        - "My ear hurts"  I diagnosed a ruptured eardrum, and the patient wanted to know what I was going to do to "fix it."  I attempted to explain that they usually fix on their own, but she said that she couldn't hear and needed something done sooner.... yeah, um...

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1200 - Help arrived, I don't have to pick up any new patients, however I had a pile waiting to be seen still
         - Concern for stroke, from Wisconsin, fellow cheesehead...
         - SVT and COPD admitted for both
         - HA with concern for head bleed because of prior history of head bleed
         - AMB - Concern for stroke with dementia, makes for a difficult physical exam
         - Pediatric asthma... parents, STOP SMOKING..!!
    
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1300 - Trying to clean up from the day.  Labs to be reviewed.  Radiological studies to be followed up on.  They say on average an ED physician gets interrupted multiple times a minute.  I'm wrestling with managing over a dozen patients at once including the lingering sign-outs from the morning, especially one that is cursing at staff and telling everyone around them to F-off.  They're over 70 years old by the way...

1330 - Lunch while I chart!

1345 - Underage patient who smokes pot they "find around the house" here with concern that their "tongue is going to fall off."  They sit on the ambulance gurney holding onto their tongue so it doesn't.  I ask them to put their tongue back in their mouth.  They instantly realize they can and try to jump off the gurney saying "I'm all better I can go now!"  But, they can't because some of the other medications they "farmed" around the house are kicking in and they start to vomit.  I'll be signing this one out for sure.

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1400 - I'm under the gun.  My scribe has left and I need to finish discharging/admitting/transitioning patients while I continue to be interrrupted and the other MD is getting overwhelmed by the waves of humanity.  Funny how fast things can change.  Yesterday at this time there were 10 patients on the board, no one in the lobby, and I was leaving my shift early... now there's a full board of 25+ patients along with 22 in the lobby, the longest of which has been waiting almost 3 hours...

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1430 - I've got almost everyone admitted who's going to stay including the back pain because it just "hurts too much to walk" despite dosages of narcotics that would have me (and most people) unconscious for the next 36 hours.  Still waiting on call backs from admitting physicians.

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1530 - The last of the admitting physicians have called back.  Everyone is signed out.  I am headed home... whew!











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