The type of Emergency Medicine story that gets your heart racing. (Also got a nice kick out of him linking to MDCalc for the Parkland Formula .)

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(If you’re squeamish, this isn’t the post for you.) There’s a total RIBBFOMP story and photo over at White Coat Rants , hand versus snowblower. If you’ve always wondered what the tendons look like that allow your fingers to flex and extend, but never wanted to take the anatomy class, there’s a perfect specimen in the post. Wow.

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Shadowfax finds a kidney stone in a “known drug seeker” and treats her with toradol. Success. I had a somewhat similar case with a “known homeless drunk” who had pretty severe electrolyte derangements after I bothered to check, despite nurse balking. Only re-iterates the point: trust no one.

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My own ED is blogging? How did I not know this? Straight Talk from the Stanford ED : go Cardinal. Maybe people will realize we see more than just horse accidents down at the Farm.

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The rumors of my demise have been greatly exaggerated, even though my first night of call as a sub-intern was incredibly, incredibly painful . It’s scary to actually admit it, but I… kind of enjoyed my Internal Medicine sub-internship. Yes, I know, this is crazy talk, especially having found my prior medicine months a bit slow, but the constant hypervigilance required to make sure all your patients’ labs get drawn and studies get done is, in a small, small way, similar to the constant nature of the ED.

I enjoyed it so much, and felt so comfortable managing the patients there that I even wondered for a few minutes, “Am I going into the wrong field?” Of course all my medicine colleagues asked me the same thing, and always had their own opinions about Emergency Medicine (I’m used to getting ragged on by pretty much every service by now, so it’s fine).

Calls went incredibly smoothly–probably another reason I enjoyed the month so much. We only capped (received the full number of patients we’re allowed to have) twice in the entire month, once on our first day, and the other we’d capped by 11am, since most of our patients came in overnight and were already tucked in by a fantastic night float resident (thank you, Cheryl!). Taking a note from the ED playbook, I was king of dispo, able to discharge half of my patients by post-call time! (Which often makes you wonder if they needed to be admitted in the first place.)

I definitely learned a ton, and feel comfortable writing diet and DVT prophylaxis orders now. Overall, a really great month.

I think the deal-breaker, however, is summed up today in clinic. I was reading the latest ACEP Newsletter . In the Tricks of the Trade session (written by an awesome mentor of mine, Dr. Michelle Lin!), she mentions unique uses for wall vacuum suction, including how to remove a foreign rectal vegetable using vacuum tubing and bulb suction. What other specialty talks about that in their monthly newsletter?

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Shadowfax’s hilarious and freaking bizarre story of a guy seeing Christmas elves reminds me of a patient 2 months ago who, when asked if he knew why he was in the hospital, answered, “I’m here for a meat inspection.” He told this to multiple people.

And my roommate’s girlfriend had a patient who, when asked the date, would frequently answer “6007” for the year.

So, what’s your weirdest chief complaint/response to orientation question? (Comments are open!)

(Update, I take that back, my best one-liner was in the ER awhile back. The chief complaint, which I’m sure the triage nurse got a kick out of writing–since she’d normally just write “altered mental status” was “911 called by roommate, patient was meeowing like a cat in his room.)

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How to be an ER doctor from Shadowfax and Why to get EKGs by 10 outta 10.

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How it works in the ER , because it’s all shotgun medicine. Talk with patient, ask questions, feel belly. Most of the time the patient is waiting is either because there are sicker patients, you’re doing a procedure, or you’re playing phone tag or following-up on labs that are pending or didn’t get sent. Great writeup.

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Thank you to the great attending and residents who trusted me, supervised me, and allowed me to do so much today!

• Intubated a sedated (but not paralyzed) septic patient having a STEMI (my 2nd intubation ever)
• Got an ABG on the first try
• Lac repair of a partially avulsed finger skin flap
• Lead a basic trauma resuscitation
• Put in a foley on a comatose patient
• Stapled a scalp lac

Done most of these before, but it was in such rapid succession–one procedure after another–that I totally felt in the zone. It was great!

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Sewed up several intraoral lacerations lately, one attending never mentioned antibiotics, the other was pimping me on which to give. Looks like there may be some benefit in compliant patients for reducing likelihood of abscess formation .

(Actively bleeding through and through lacs (ie: they go thru the skin and all the way thru the lip and gums into the mouth) are a pain in the ass to close and close well, especially when they don’t respond to lidocaine with epi! That being said, I think I did some pretty good vermillion border work, even with the crappy throwaway instruments and blood everywhere.)

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