Family Medicine

Hello, it has been a while.  So much has happened I dont know where to start.  The last post was about ER so i will talk about Family Medicine rotation.  I did this rotation in February and March of 2012 with Dr. Hassrick at the Ogden Clinic. Most of the patients were your run of the mill upper respiratory illnesses and yearly checkups.  Dr. Hassrick also does on call substitution for people who come to Ogden to have their babies who live from farther away places like Evanston WY and such, so he gets to go check on the newborn babies and their moms.  This means that we got to do some circumcisions.  Not the first, most exciting thing on some peoples lists, but when you are a PA student it is awesome.  I was able to perform about a dozen, with more than half of them done on my own (with the Dr. supervising of course).  They all were using the Plastibel method which I found to be very easy to use.  I also had an interesting case with a young man who was having some ADD/ADHD issues with trying to go to school and work at Arctic Circle.  It was causing his mother some issues as well, and we tried to help them the best we could.
I also was able to spend some time with the general surgeon, the orthopedist, and the dermatologist this month.  Dr. Hassrick allowed me to remove some moles and stitch them up.  On one such incident I stuck myself with the suture needle and had to do some bloodwork.  Overall it was a good month, and I feel like a learned some about URI's and how to do a yearly physical exam.

I loved ER!

Well I am sad to say that my ER rotation is over. I really had a good time and learned a lot. I got to do some good procedures in my last week. The last day I spent in the EDx with Karen was awesome. I got to do a paronychia w a digital block, an ingrown toenail w a digital block, an I & D on the sole of the foot w a local block, and an effusion aspiration of the knee w local block. I also did some splinting and other regular sort of exams too! So for all of these procedures I was able to do them BY MYSELF :) This made me feel like Karen really trusted me to do them and to take care of the patients properly.
My last day was with Brian and my last patient was kind of sad. He came in with A fib and chest pressure and some pain in his shoulders which progressed into runs of PVC's. About 10 minutes later he was very pale and diaphoretic. A new EKG showed ST elevation, so we intubated him and sent him upstairs to the cath lab....but he didn't make it. He passed away in the cath lab from a total LAD blockage. He already had 4 drug eluting stents in his heart, but the blockage was up high in the LAD above the bifurcation so a large part of his heart was occluded and there wasn't anything that could be done for him. This was a difficult case, but a good one to learn from.
OH YEAH! I forgot to talk about the dog bite lady in my last post. She broke up a fight between her doberman and lab and had a TON of dog bites on the right side of her body. Her wrist and ankle were pretty swollen with puncture wounds on it, and I thought that she may have some fx's so we got some x rays. Sure enough she had an ulnar avulsion fx from the dog bites, and needed surgery to take care of the Fx. This was a good case, and I got to help clean out the puncture wounds and splint her arm.
So overall I really liked ER. I liked seeing all the different things all the time and being able to order tests and drugs and do procedures.....It was GREAT :)

ER!

January 2012 is my month to work in the ER. I am at McKay Dee Hopsital following Dr's Brian Smith, Karen Bossler, and Amber Mounday. In the beginning I was really overwhelmed by the speed with which patients are seen in the ER. But now, 23 days into the rotation, it doesn't seem quite as bad, but definitely still faster than I would be able to do it. I have worked in the EDx, which is like the "now care" section of the ED. I like it over there, as there is more minor trauma patients and less severely ill patients. This is more my speed. I have gotten to perform some new procedures in the ER! These are a shoulder dislocation under conscious sedation (propofol); this was neat because I felt the shoulder "clunk" back into place! I have also performed some quick caths, my first on an infant that didn't go so well, then 10 minutes later on an older lady which I got my first try. I have done a few of these cath's since and feel fairly competent with this procedure. I have helped relocate a displaced lower leg fracture and a displaced radius/ulna fracture. I saw a "blood bath" from a little old man who pulled the IV out of his arm and sprayed blood all over the exam room. I watched Amber perform a lumbar puncture on a lady with encephalitis. I got to do 7 stitches by myself - completely by myself with no doc even near the room - on a guy who was stabbed in the back 3 times with a screwdriver after being hit in the head with a cinderblock by his girlfriends son and his friends..... glad they are not my kids. The doc, "burkules", was dealing with the family of a 93 year old non responsive man, and came in to check on me as I was finishing. He said they looked good and gave me some tips on how to make it pretty for the patient, as that is how they judge just how good of a job I did. I have also done a nasal cautery on a young man for an anterior nosebleed, placed an NG tube, and removed a J tube. I have really liked working in the ER so far, and have enjoyed getting to know my preceptors a little better! I have worked some crazy shifts like 10 pm-6 am and 6 pm - 3 am. Lets just say there is a lot of sleeping going on after these shifts!
I got a sinus infection over Christmas that is finally cleared up.....One month later I am finally feeling "normal".
It has finally started snowing this season. I have been up 2 days for control work, and trained a couple of new patrollers - Lisel and Dickie - on control route in Sunshine bowl. We are on control alert for tomorrow, and since I don't go in to the ER until 2pm I might try to go to control.