Watched B pull an 1/8th-inch wire out of someone's finger with forceps. I was duly impressed. He also brought me a Dermabond practise kit, so I swiped a scalpel to practise with too. He also says I can work on hot dogs instead of the fake flesh. Angel fears my Dermabond practise.
Dr. E sent me to see a large woman who was feeling bloated. "Well, what're you going to order?" Did an ultrasound to rule out ascites, CBC and electrolytes because she's on dialysis, and considered a liver panel. And then, suddenly, the nurse tapped me on the shoulder. "Um...lab just called in a panic value for her potassium." Normal range: 3.5-5.5. Her value: 7. Whoops. No wonder she feels funny. So we sent her to be dialysed a day early.
Watched a shoulder reduction on an old lady. She was so skinny, I could see the bone pop back into place. *shivers*
Saw an 81-year-old man who'd tripped and fallen off of his driveway. Dr H: What, does he drive a monorail? Driveway's elevated about two feet from the grass. Dr. H: So it's a hovercraft... He ate some dirt, wound up with the biggest hematoma (blood-blister/bruise) under his eye. And there I am, trying to do a neuro evaluation, and he's had a stroke on that side. So his pupil always looks funny, and his vision's always blurrier, and he has decreased sensation, and I just gave up. CT'd his head, did a chest X-ray and an EKG and a UA. All normal. Microscopic analysis of the UA revealed sperm present. Dr. H: Good for him! So we sent him home with ice and Tylenol.
Little boy with a headache and fever and a sore throat. A little bit of RUQ tenderness. Dr. H spent several minutes prompting me, but I was stuck on "do a strep screen" and couldn't get anything else. Apparently, anyone can get mono. Even little kids, although it's rare under the age of two. That's what he was looking for. Insert me blushing. Oh, and ishotkenney: Little kids don't have frontal sinuses until between the ages of 3 and 7, older according to some people, so watch out for a sinusitis diagnosis in a baby :)
Lots of questions about what meds I'd prescribe. Almost none of them did I give a satisfactory answer, but he was patient with me. I got explanations for why I was wrong, at least.
Saw a truck driver with chronic back pain from Georgia and thought about my Lily, briefly. Extra-strength tylenol and Skelaxin so she can keep on truckin' :)
Then, near the end of the evening, came the 13-year-old boy with strange neurological symptoms and a headache off and on all day. Dr. H ordered a West Nile panel, did a head CT and a lumbar puncture (spinal tap, for the uninitiated). So I got a procedure signed off today, since I only have to watch them, not do one this year. All negative, West Nile will take 72 hours to get done.
Had bigeminal non-perfusing PVC's explained to me as S came in on a cart with a pretty cool-looking EKG strip (p-wave, QRS complex, wide QRS complex with no associated arterial pulsation, p-wave, QRS, wide QRS with no associated arterial pulsation, etc.), and a whole list of meds. Been complaining of a dry mouth. He's using a nebulizer 3-4 times a day, and Dr. H said "Are you using the ipratropium bromide every time?" Why, yes, why? Use it every other time, he says. It'll give him a dry mouth. Now why didn't the family doctor think of that? Nobody ever told them.
Left at 10:20 to discover that the Pepsi previously serving as emergency refreshment in my bag had been punctured and leaked everywhere. I hope the lab will take a half-drenched-in-Pepsi order for drawing my blood. Wore my scrubs home, since my clothes were suspiciously damp feeling. Stopped at Wal-mart and bought corn, DVD's, a heating pad, some anti-shoe-stink-powder, and Monistat for that horrid itchyness that's been driving me nuts. There, now you know what sort of strange things I buy at Wal-mart in the middle of the night on my way home. Got some odd looks for the scrubs.
Kudos to ishotkenney for making it through her first day of NICU, which is a wicked hard place to start. Even more kudos to the nurses and doctors she worked with there for making it a hopeful place.
Back in for the last day at 0800, it's bedtime now.