What a shift....

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EctopicFetus

Keeping it funky enough
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I probably had my slowest shift in the 2+ years I have worked at this job. I worked a 12 hour shift and in that time saw 18 patients which wouldnt be a big deal except in that time I had

1) 2 patients I intubated including one who has COPD exacerbation/Pneumonia, a PCO2 of 70 with AMS, a high grade SBO and a SBP of over 260.

2) a young heroin junkie with endocarditis and septic pulmonary emboli

3) a lady with Septic thrombophlebitis extending from the IJ to the level of C2

4) a guy with a sugar of 29 for about 30 mins prior to arrival

5) 2 Level 1 traumas including one with a comminuted femur fx, distal radius fx/dislocation and a SBP of 70.

I cant remember the last time I felt I really busted my butt only to realize I saw 1.5 pph:laugh:

On another note the hypoglycemic guy got me wondering.. He was on Actos only for his DM, has CRF with a Cr of 4-5 at baseline. Actos should not cause hypoglycemia. Wondering if I am missing something his other meds were for BP. Wondering if you smart guys/gals have any insight.

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I probably had my slowest shift in the 2+ years I have worked at this job. I worked a 12 hour shift and in that time saw 18 patients which wouldnt be a big deal except in that time I had

1) 2 patients I intubated including one who has COPD exacerbation/Pneumonia, a PCO2 of 70 with AMS, a high grade SBO and a SBP of over 260.

2) a young heroin junkie with endocarditis and septic pulmonary emboli

3) a lady with Septic thrombophlebitis extending from the IJ to the level of C2

4) a guy with a sugar of 29 for about 30 mins prior to arrival

5) 2 Level 1 traumas including one with a comminuted femur fx, distal radius fx/dislocation and a SBP of 70.

I cant remember the last time I felt I really busted my butt only to realize I saw 1.5 pph:laugh:

On another note the hypoglycemic guy got me wondering.. He was on Actos only for his DM, has CRF with a Cr of 4-5 at baseline. Actos should not cause hypoglycemia. Wondering if I am missing something his other meds were for BP. Wondering if you smart guys/gals have any insight.


Was the guy with the hypoglycemia also drunk? alcohol can also cause a prolonged hypoglycemia, more pronounced in kids, but throwing something out there :)
 
No not drunk.. Not a child.. 55 or so.
 
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I had a very similar shift last week. 12 pts in 8 hours.

Of course one of them was a guy with cardiomyopathy in afib w rvr and a bp of 50. Cardioverted, intubated, central line, multiple pressors and then helecopter to the mecca for level 1 transplant eval - spent 2+ hours on him

2nd one was a bad copd'er on multiple nebs, bipap, flipped into SVT at 250, multiple rounds of adenosine without change, considered cardioversion on her, but got controlled with slow dilt pushes.
 
I often have slow days as we're working on building volume back up after competition moved in. One hospital was built 2 miles away and a free-standing ED was built in our end of town. There's another one going in soon just a few miles away too. Eventually I think there will be enough people in this part of town to justify all these EDs, but until then we have fewer patients than we'd like. A typical shift is 13-15 patients in 8 hours, but I've had plenty of 8-10 patient days. I'd like to see us get to the point where we're averaging 20/shift.

Of course, 10 patients per shift from a good payer mix is a lot better than 20 from a bad payer mix, which is the situation in a lot of places.
 
Started my new job and do to holds only saw 14 patients in 11 hrs. First patient of the day had cc of weakness and ended up being hypokalemic periodic paralysis associated with hyperthyroidism.
 
Oddly enough this was my slowest shift there in the 2+ years ive been here. I average right around 2 pph. Ditto on the payer mix thing. We are pretty fortunate from that point of view.
 
Hardest job in Medicine: ER physician. Keep up the good work.
 
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