First week in Emerg

So I just completed my first week in the ER. I was expecting it to sort of be a cluster f*ck of everything from traumas, copd exacerbations, psych admits,seizures, cardiac arrests, broken bones, etc. I thought I was going to be running around the ER like a chicken with my head cut off. Not so much.I did send see the exacerbations, concious sedations, siezures, psychs, fluid overloads but it was more controlled then what I was expecting. We even had a lot of free time to help out on the wards and see patients there. That is one of the great things about this Hospital and it's RT department. Everyone gets along and helps each other out. It seems to be a good group here.

I got calls to see pediatric patients, elderly patients and patients that looked like we might have to call a code on them. But with a little bit of bipap and some lasix, these patients were off the machine and sitting up and smiling and joking around an hour later. It is kind of amazing what a little intervention and therapy can do. I got to give some ventolin and atrovent by nebulizer quite a few times as well as by MDI. I set up some high flow systems and did a lot of blood gases. Got to interpret a few CXR's and auscultated a lot. Auscultating an actual patient sounds a little different then auscultating the machine we listened to in lab and got tested on. People come in all shapes and sizes and you need to listen all over and compare side to side. Some peoples fat blocks the sound,others heart beat or stomach sounds are louder than their breath sounds. Getting patients to take deep breaths and NOT talk when you auscultate them is the key.It is also easier if they tend to stay somewhat still. It makes it just a bit harder if they are moving/rocking back and forth and for one reason or another you can't get them to settle and move less.

All in all I liked my ER rotation. You never know what the paramedics are going to wheel through those doors. Those same paramedics are also interested in learning and where asking me questions and possibilities of what could have caused the patients illness and what types of therapies we would be providing. I also learned something kind of important in the ER. Make sure you move the sat probe to a new finger every once in a while. Sometimes a patient can sweat a little and you look at the waveform and it looks normal and their SpO2 is 93%. You trial them off the high flow face mask and see their SpO2 drop to 88% so you put them back on and up their FiO2 to get their sats up. Later on the nurse comes by and during their routine check ups changes the sat probe and you find the patient SpO2 to be 98-99% and the nurse informs you there was a lot of sweat on the finger where the probe initially was. Sweat will give you incorrect SpO2 measurements.