another day in paradise

[umza]

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Sooo, just want to vent about how amazingly little I know and how much I need to learn... Second shift in Adult Emerg...
a) Machete wound to cheek. closed in two layers, 3 inches long. etoh++. hiv+ hepc+ yuk
b) Fingertip ripped off by lumber, try to reattach ball of mush and squeeze in subq fat pads.... double yuk.

Feeling really inadequate when unable to suture these dudes, but even the
attending required extra hands to keep the subq stuff out of the way..yuk
Must remember that I do not have to know everything....this is a learning experience..still feel stupid though.

SMRT!

 

[Tired]

I'm not on Urology, but I have to cover it when on call. They only have one patient in-house tonight, but he keeps peeing blood. What the hell do I know about peeing blood? It's only about 50cc at a time, and it's only once every 2hrs. His hgb is stable, his vitals are stable, he feels fine, but he keeps peeing blood. I called the Resident a couple times (home call) but he tells me not to worry about it.

But God-in-Heaven, he keeps peeing blood, and I have no idea what it means or if I should worry about it, so I keep going to see him every hour just make sure he's not going to die on me.

I hate cross-cover. A dozen stable Ortho patients I normally follow haven't made a peep all night. But the one Urology patient I don't know keeps doing the one thing I know nothing about . . .

 

[umza]

I totally feel for you..

I too know very little about hematuria, but, it could come from his kidneys (nephritis) or his bladder (cystitis) or elsewhere along the trip (kidney stones).. is he postop from a turp? maybe a u/a could tell if his kidneys are the source or hell I don't know.

Hope he makes it through the weekend.😴

 

[Tired]

I totally feel for you..

I too know very little about hematuria, but, it could come from his kidneys (nephritis) or his bladder (cystitis) or elsewhere along the trip (kidney stones).. is he postop from a turp? maybe a u/a could tell if his kidneys are the source or hell I don't know.

Hope he makes it through the weekend.😴

One is s/p TURP. But kind of far out, like 5-7 days. I have no feel for the natural history of these procedures, so I have no idea if that's normal or not. The other guy is worse, also s/p TURP, but with a ureteral stent, nephrostomy tube, and metastatic prostate CA. Bleah.

Since the fellow told me not to worry, I'm just treating it like chronic blood loss. Check a CBC a couple times during the night, watch vitals and clinical status, and make sure I don't have to transfuse. Lord, only six hours to go.

 

[I am Hans]

I feel for ya Tired...

when I was a resident and rotating at the VA, we (gen surg residents) used to have to cross-cover the Uro, Ophtho and Ortho patients who may have been in-house.

Now I had an interest in Ortho and even scrubbed on a few of the cases, so those weren't the hard ones. Ophtho staying over was once in a blue moon. But the Uro patients, while not frequent and not many stayed over, always confounded me because I knew nothing about them and my gen surg books didn't cover those topics well. Fortunately, the Uro residents were always very friendly and helpful when I called although I could never understand why THEY weren't first call instead of me.

 

[smq123]

Machete wound to cheek. closed in two layers, 3 inches long. etoh++. hiv+ hepc+ yuk

Did you say "machete"? Are they very common in Canada?

 

[umza]

machete and knife >> gunshot wounds in Canada