Ya know, I worked with one of our new, younger attendings on my overnights this week (he gives us a lot of freedom in making decisions and running the show in the ED), and I realized how much I love my job (even though I'm still a resident).
In between the colds, coughs, kidney stones, and croupy kids, i saw some truly weird stuff over the past night or two...
1. A 12 year old boy with CREST syndrome who came in with an approximate 100% spontaneous PTX on the right. Put in a 20F chest tube, and then sent him to the big peds hospital down the road. Turns out kid needs a lung transplant ASAP because his lungs are just a bunch of blebs waiting to give some other resident the joy of putting in chest tubes.
2. A 70 year old prev. healthy woman who came in with a left sided thalamic stroke....worked her up per our stroke team stuff, and admitted her. Her 2D echo and subsequent TEE showed a huge atrial myxoma which will be promptly removed in the morning.
3. A 62 year old man came in with SVT and vision changes for an hour, and ended up having an occipital bleed (he came in with a SPB of 130 in his SVT, and after we cardioverted him with the Adenocard, his BP shot up to 240's systolic).
4. A guy with a cystic mass in the sub-q tissue in front of his maxillary bone with lytic destruction of the maxilla, and on further CT, a cavernous sinus thrombosis.
My attending and I got to talking during some of the downtime, and we just commented on how amazing it is to see your run of the mill stuff, and then have to jump to the crazy things immediately. Really gives you an appreciation for what we have to deal with on a daily basis.
In between the colds, coughs, kidney stones, and croupy kids, i saw some truly weird stuff over the past night or two...
1. A 12 year old boy with CREST syndrome who came in with an approximate 100% spontaneous PTX on the right. Put in a 20F chest tube, and then sent him to the big peds hospital down the road. Turns out kid needs a lung transplant ASAP because his lungs are just a bunch of blebs waiting to give some other resident the joy of putting in chest tubes.
2. A 70 year old prev. healthy woman who came in with a left sided thalamic stroke....worked her up per our stroke team stuff, and admitted her. Her 2D echo and subsequent TEE showed a huge atrial myxoma which will be promptly removed in the morning.
3. A 62 year old man came in with SVT and vision changes for an hour, and ended up having an occipital bleed (he came in with a SPB of 130 in his SVT, and after we cardioverted him with the Adenocard, his BP shot up to 240's systolic).
4. A guy with a cystic mass in the sub-q tissue in front of his maxillary bone with lytic destruction of the maxilla, and on further CT, a cavernous sinus thrombosis.
My attending and I got to talking during some of the downtime, and we just commented on how amazing it is to see your run of the mill stuff, and then have to jump to the crazy things immediately. Really gives you an appreciation for what we have to deal with on a daily basis.
