Monday, September 05, 2005

Bustin' Loose

I'm free!

My last shift in the E.R., potentially my last shift in the E.R. of all time, was Saturday during the 7am-7pm shift. Overall, it was actually one of the most satisfying ER experiences of my short career down there.

A 70-ish year old woman was brought in by EMS with altered mental status, a blood pressure of 60's/30's, tachy in the 130's (which turned out to be new A-Fib, an abnormal heart rhythm), and belly pain. We weren't sure what was going on at first...we debated about whether to shock her back into sinus rhythm straightaway, but decided against it, thinking that it was probably something else that was the primary process and that the A-Fib was secondary. Had difficulty with iv access so we scrambled to put in an EJ vein (a small peripheral iv in the external veins of the neck) and then later managed to put in an internal jugular central catheter (a larger iv in the internal veins of the neck). After pumping in about 4 Liters of normal saline and giving 3 different iv antibiotics, her blood pressure was back into the normal range of about 120/70 and her heart rate was in the 80's...interestingly, now in normal sinus rhythm rather than A-Fib! I'm still not sure exactly what the underlying cause of her illness was--it could be some kind of serious intra-abdominal infection, or it simply could have been profound dehydration (she said afterwards that she probably hadn't been eating as much as she usually did & her house didn't have air-conditioning, and it had been a pretty hot week outside). However, we managed to turn somebody who looked like she was on death's door into somebody who's not in the span of a couple of hours. I admit, this is one of the cool things about the E.R.--you are the first line of defense, and often are in a position to help people the most!

As for the Shawshank reference....number one, I'm damned excited to be finished with this ER rotation and enjoy a normal lifestyle for a month or so, as I have sweet, sweet elective & vacation for the next month!


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