ER day 11: Procedure day

I went to go see my first patient of the day, all I knew was that the nursing home was sending him in for "unresponsiveness", and that's all he'd been triaged as. I go over to the bed, and shit. The guy was blue.

I left the bed ran over to the attending at the nurses station and said like a cool doc: "I think we need to intubate nursing home guy, he's REALLY cyanotic". So then I was helping the attending intubate the guy, then place an NG tube on him. Pretty exciting start to the day.

Maybe 20 minutes later, another patient arrived that needed a central line put in. Whenever that needs to be done in the ER, they usually call for the surgical resident to come and do it. Being the overexcited little bugger I am, I asked the surgical resident if I could watch, and promptly dumped my ER duties to check it out.

The central line was cool. It was kinda like an ABG, in that you are taking a big needle, and basically trying to hit a hard to get blood vessel. They had to thread some big thing up it tho, and there was something involving a scalpel (I did end up getting called away halfway thru), but in the end, they actually sutured the thing into the patients skin.

For awhile, there wasn't much going on, so I sat at a computer pretending to be busy.

I figured something cool would come along soon, and I kinda didn't feel like seeing the boring cases like pediatric fevers, or old people with arthritis pain today.

Then I got the call.

"Are there any medical students here?" The charge nurse asked. Oh oh me!!!!

"Dr. S over in the fast track area wants to see you".

Fast track is a small area off to the side of the ER where they take the less critical patients. I walked over there, and Dr S was standing there next to Dr. B. Dr B is a double specialized plastic surgeon and Ear Nose Throat (ENT) guy that we sometimes call in to consult on cases. Dr B loves to teach, so anytime he is in the ER, he likes to have students and residents around.

Dr B asked "Hey Alanna! You're the ER student today right? Did you happen to see any surgical residents over there?"

(ok I did, but fuck them) "No sir I didn't". (I know I'm bad)

"Well they are missing out. I guarantee you won't see something like this again" he told me.

And then he brought me over to the patient. This guy had a bike accident, and he managed to tear his ear half off. He showed me how some of the cartilage had become necrotic and black already. We basically had to cut out the dead cartilage and tissue, then reconstruct the ear using tissue from behind the ear and skin pulled down from the skull. He taught me a bunch of plastic surgery stuff while doing all this. Then came the awesome moment. "Ok kiddo, want to show me your suture abilities?"

"Yes sir!!!" So he let me do a bunch of the sutures in the less complicated parts. It was really awesome because he was critiquing me as I did so, and I think I got a lot better at it with his help. In the ER, they usually don't care so much cosmetically, they just want the two ends of skin to come together. But he showed me how to do some plastic surgery grade sutures, and how to make sure it will look good when you are done.

So that was my procedure filled day. I'm off to take a nap, have night shift again tonight!!! See you later :P