Sorry about the spellings on your screen names but its been a month of residency. How's the first month been? biggest surprise, biggest disappointment. best/worst moment. has it been what you expected?
calling Quinn, Edinoh, mikecwru, Apolyon etc...
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North Carolina is a hole. That's ALL I'm saying! At the same time, the PD has been GREAT - it is something to be part of a program where they care about you as a person, and not a $.
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Thus far it has been pretty much what I expected. We spent most of the month in class with lectures over the big stuff basically from a complaint point of view (CP, SOB, abd pain, altered LOC, etc) plus we did ACLS, PALS, instructor courses of the same, and ATLS. We finished off the month working a few shifts.
The shifts have been excellent. I can actually feel the learning curve change by the hour while in the dept. Much of that is just kicking off the rust. The biggest difference is understanding that people will actually carry out the orders you write. This is good motivation to make sure you know what you are writing/talking about.
Interesting experience the other day. Pt. arrived via nursing home van (seriously) and dropped off at our door with a pulse around 30 and a pressure in the 50's. The nurse told me that someone needed to see the pt. so of course I went to check her out. Being the astute intern that I am
I immediately realized the pt was in trouble. Long story short, I notified my attending of the situation. He pretty much said, "Well, you know what to do. Let me know if you have any problems" (I'm thinking her vital signs are a problem, don't you think?) Anyway, after a couple doses of atropine it was obvious that pacing was needed. So I grabbed the pacing pads, ordered some ativan, and fired away. Ultimately captured around 80 beats/min, hung dop and called for a bed. About this time her chart shows up and of course she is DNR! Still great experience though. We continued until all the family got there. I think they took her upstairs and unplugged her.
The point is that I was really surprised that I was allowed to handle the situation as independently as I did. I got through it and it was a great learning experience. I guess that's the difference between being a medical student and a doctor.
Start inpt peds in the morning. God help me.
The shifts have been excellent. I can actually feel the learning curve change by the hour while in the dept. Much of that is just kicking off the rust. The biggest difference is understanding that people will actually carry out the orders you write. This is good motivation to make sure you know what you are writing/talking about.
Interesting experience the other day. Pt. arrived via nursing home van (seriously) and dropped off at our door with a pulse around 30 and a pressure in the 50's. The nurse told me that someone needed to see the pt. so of course I went to check her out. Being the astute intern that I am
I immediately realized the pt was in trouble. Long story short, I notified my attending of the situation. He pretty much said, "Well, you know what to do. Let me know if you have any problems" (I'm thinking her vital signs are a problem, don't you think?) Anyway, after a couple doses of atropine it was obvious that pacing was needed. So I grabbed the pacing pads, ordered some ativan, and fired away. Ultimately captured around 80 beats/min, hung dop and called for a bed. About this time her chart shows up and of course she is DNR! Still great experience though. We continued until all the family got there. I think they took her upstairs and unplugged her.The point is that I was really surprised that I was allowed to handle the situation as independently as I did. I got through it and it was a great learning experience. I guess that's the difference between being a medical student and a doctor.
Start inpt peds in the morning. God help me.
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Hey Randy,
I just finished my month orientation in the ED. It was a lot of fun, and I'm finishing my first week of floor peds, too. The nurses in the county ED are a lot more independent. But on peds, you get called for everything. They have a section of chromosome kids who are difficult sticks and I tried to help out by using one of the new U/S machines in the ED, but I just got trained on U/S the day before and I couldn't find a vein that wasn't next to something pulsing... trying to save the kid a central line.
It's a bitchslap to go from seeing multiple pts at once and taking care of the immediate problems, to having much fewer pts and worrying about EVERY little thing.... ("Are there any pets in the house?") I reaffirm my career choice anyway.
PS: You did the right thing with the old lady if you didn't know.... was she a DNR arrest or comfort care-arrest?
mike
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Besides the pets, don't forgot to ask about carpeting as well as smoke detectors.....and, what about that all important question on birth weight and immunizations...........then, depending on where in the country you are, you may have to ask that 12 year old about periods, sexual activity, smoking, alcohol, etc.
As for edinOH...good job with the patient. Also have to remember, there are a lot of different DNR types. And, many of them just don't want CPR, intubation, defibrillation, etc. but are OK with pressors and many of them will be fine with pacers. Just out of curiosity, once you put the transcutaneous pacers on, did you float a transvenous one? Or is that something that is typically not done in your ED?
As for edinOH...good job with the patient. Also have to remember, there are a lot of different DNR types. And, many of them just don't want CPR, intubation, defibrillation, etc. but are OK with pressors and many of them will be fine with pacers. Just out of curiosity, once you put the transcutaneous pacers on, did you float a transvenous one? Or is that something that is typically not done in your ED?
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Damn edinOH,
Nice work.
I think the biggest "change" for me is what has been talked about in this thread... that people will actually do what I say. I think with that comes a series of "checks and balances" in your head that you didnt' have as a student. As a student, I would be pretty close-minded about what would be the best treatment... but now its great when someone comes in with severe CHF and I'll just give 'em 3 or 4 things to work with (Tridil, MS, Lasix, CPAP) and come back in a few minutes to see if anythings working. That's real fun I think.
I did two codes on my own (with an attending next to me, the benefits of being the only EM residents in the program!). That was definately an experience but v.v. cool. Both ended up dying but it was good to *somewhat* be in control of what to order and etcetera. Yesterday the attending had me come along to announce the death to the family. He did it pretty much by textbook (Tintinalli's) so it wasn't too tough. But, wow.
I'm now starting my CCU rotation. Initially I was pretty scared (I even posted a thread about it, and MCWRU gave some good advice), but now I dont' think it'll be bad. I'll be HO for the nights I'm on call (Q4), and believe it or not, I think it will be fun. I like the challenge... but we'll see. Thankfully the resident will do all the admissions, I just carry the HO beeper and the code beeper.
I think the learning curve has been pretty steep this past month (last two weeks of July was straight EM shifts)... but I obviously realize how much I really don't know... but its all good, because we all have to learn at some point.
Had my first morning report with the IM interns/residents... THAT was a complete BORE. How many times can they discuss the sensitivity and specificity of the Legionella titer.
Q, DO
Nice work.
I think the biggest "change" for me is what has been talked about in this thread... that people will actually do what I say. I think with that comes a series of "checks and balances" in your head that you didnt' have as a student. As a student, I would be pretty close-minded about what would be the best treatment... but now its great when someone comes in with severe CHF and I'll just give 'em 3 or 4 things to work with (Tridil, MS, Lasix, CPAP) and come back in a few minutes to see if anythings working. That's real fun I think.
I did two codes on my own (with an attending next to me, the benefits of being the only EM residents in the program!). That was definately an experience but v.v. cool. Both ended up dying but it was good to *somewhat* be in control of what to order and etcetera. Yesterday the attending had me come along to announce the death to the family. He did it pretty much by textbook (Tintinalli's) so it wasn't too tough. But, wow.
I'm now starting my CCU rotation. Initially I was pretty scared (I even posted a thread about it, and MCWRU gave some good advice), but now I dont' think it'll be bad. I'll be HO for the nights I'm on call (Q4), and believe it or not, I think it will be fun. I like the challenge... but we'll see. Thankfully the resident will do all the admissions, I just carry the HO beeper and the code beeper.
I think the learning curve has been pretty steep this past month (last two weeks of July was straight EM shifts)... but I obviously realize how much I really don't know... but its all good, because we all have to learn at some point.
Had my first morning report with the IM interns/residents... THAT was a complete BORE. How many times can they discuss the sensitivity and specificity of the Legionella titer.
Q, DO
My first month was interesting. I didn't have any patient care responsibilities but I got to do some cool things.
Spent the mornings in the OR intubating as many people as I could get my hands on. Then on M/W/F I flew on the helicopter with a senior resident getting oriented to the flight physician role. Tues and Weds (when not flying) I did ultrasound training. Tuesdays it was just me and the ultrasound guru scanning, then weds, it was a group effort with me a second and third year plus the guru scanning and reviewing tapes of ultrasounds. Thursday afternoons it was toxicology rounds. I also had the honor of giving the first intern lecture during our weekly EM conferences. All in all not a bad month.
This month is going to be more mundane I guess as I'm in the Pedi ED.
I also experienced the difference between med student and intern. After bringing a very sick patient in on the helicopter I was watching them work her up when the senior turned to me and said "tonem" get a femoral line! It was pretty cool being involved at that level (no more rectals and foleys!!!)
Spent the mornings in the OR intubating as many people as I could get my hands on. Then on M/W/F I flew on the helicopter with a senior resident getting oriented to the flight physician role. Tues and Weds (when not flying) I did ultrasound training. Tuesdays it was just me and the ultrasound guru scanning, then weds, it was a group effort with me a second and third year plus the guru scanning and reviewing tapes of ultrasounds. Thursday afternoons it was toxicology rounds. I also had the honor of giving the first intern lecture during our weekly EM conferences. All in all not a bad month.
This month is going to be more mundane I guess as I'm in the Pedi ED.
I also experienced the difference between med student and intern. After bringing a very sick patient in on the helicopter I was watching them work her up when the senior turned to me and said "tonem" get a femoral line! It was pretty cool being involved at that level (no more rectals and foleys!!!)
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About how many people was that? Did your anesthesiologists make you stay for all the cases?
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You know this House Officer thing isn't too bad. I kind of like it, its kind of like being in your own urgent care center (minus the vag bleeders). Lots of BS calls but those are easy to handle. Only one code which turned out not to be a code.
Of course, I am only 10 hours into receiving the HO pager... I got about 12 more to go...
Q, DO
Of course, I am only 10 hours into receiving the HO pager... I got about 12 more to go...
Q, DO
I'm at UMass. As far as how many tubes I got, about 4 a day. Four days a week (Weds. morning reserved for EM conference) for 5 weeks (July was a long month). Probably around 60 when you factor in slow days (had to compete w/ CRNA students, etc..) I didn't have to stay for the whole case, just the intubation.
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Hey all... first 6 weeks have been interesting... I was in the ED until yesterday, and I started CCU today. As others have said, I think the fact that people actually listen to what I say is the coolest and scariest part of this transition. My first day, ordering a Tylenol was a big deal - now I'm functioning on a semi-confident level. Or at least I was until I stepped into the unit this morning . You swear it gets better Quinn?
. You swear it gets better Quinn?
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Well, I'm only about 4 days ahead of you in the CCU rotation. Actually most of my patients aren't in the actual unit but are in tele or the SICU. Which I dont' mind of course as i'm still getting used to the core content of cardiology. But I got my first medical students! Yippee! Too bad I'm not in the ED and can pawn off a vag bleeder on them.
Q, DO
Q, DO
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That's nice that you're getting a good experience. When I was on anesthesia rotation, the attendings wouldn't let me tube the patient for the entire first week (they said that they'd better do it because I didn't have any experience - you figure it out), until I tricked one of them into letting me start doing them.
They always expected you to stay for the entire length of the case, wouldn't let you go near a child or challenging airway, and would get real pissy if you were off-service and asked to tube the patient, even if you were scrubbing in for a surgery on that patient while on general and trauma services.
Left a real bad taste in my mouth.
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Originally posted by QuinnNSU
Well, I'm only about 4 days ahead of you in the CCU rotation. Actually most of my patients aren't in the actual unit but are in tele or the SICU. Which I dont' mind of course as i'm still getting used to the core content of cardiology. But I got my first medical students! Yippee! Too bad I'm not in the ED and can pawn off a vag bleeder on them.
Q, DO
So its now 3 days in and I'm post-call... ahhh... what I wouldn't give for a nice easy tele patient! We have a combined unit, so its like total ICU baptism by fire (CCU/SICU/MICU/NICU). I think the only time you really know whats going on is when you're post-call. By tomorrow when I get back, everything will have changed and I'll be totally out of the loop...
On the bright side... we have a team of EM people, so I get to actually work with my fellow terns and its a fun atmosphere. No fleas!
