Adventures in Medicine

Medical School and Beyond!

Internal Medicine: From Physicals to CPR

on September 14, 2015

Three weeks into my clinical rotations, which also means three weeks into my internal medicine rotation, and I have already learned a lot.  Some of which I was not too happy to find out about and others that have been very interesting.  Before I dive into some of my experiences let me leave a little insight into some clinical aspects I learned for all you medical students out there:

1.) Step 2 is 40% step 1 material so all material we spent 2+ years cramming into our heads will becoming back again in future exams despite having been told it is just to get us through step 1 and what we will need in practice and for step 2 will be learned in clinicals. 😦

2.) You might be nervous… on your first day of a rotation…on your first time doing a procedure…everyday you walk into the hospital/clinic…but each day can be fun and very insightful.   You never know what crazy patient will walk through your door that day.

3.) NBME shelf exams after core rotations will ask questions such as the best initial treatment, side effects, best diagnostic test, etc. (or so I have heard).  That said do no delay your exam take it when you are done with your rotation.

4.) Some patients will not want students around them and don’t be offended by that…yes we have to learn through practice but not everyone is willing to be the person on whom we will learn.  But don’t fret there will be more patients.

5.) You will probably be surprised about what people consider emergencies and report to the ER for!

Okay so now what you all have been waiting for…a glimpse of some of the things I have experienced! 🙂

As I mentioned in my previous post my preceptor works in both a clinic setting and the ER so I got to experience both.  While in the clinic I take the patients vital signs (blood pressure, pulse, weight, and temperature) and get an updated history (find out why the patient is presenting to the office that day, update their medication, vaccination, and procedure lists, and check on any chronic conditions the patient may have).  Then as the doctor is doing the exam I enter the information in the patients chart and she lets points out any anomalies to me.  For example, a patient this past week had fibrocystic change in her breasts and she left me feel the cyst so I know what it feels like.  In the clinic I see many patients for follow-up of high blood pressure, diabetes, and high cholesterol as well as many complete physicals.  But I must say in these past 3 weeks my charting skills have significantly improved and I am sure they will continue to over the next 9 weeks.

While I understand how aggravating it is to have to sit at a doctors office in the waiting room as the minutes tick by past your appointment time let me tell you I have seen first hand how it happens.  A patient shows up 10 minutes late.  A patient calls the office wanting to talk to the doctor about lab results or side effects of medications.  A hospital or another doctor calls as they have your patient for a consult or an emergency.  A patient mentions an important symptom or reason for the visit after the doctor already spent 20 minutes with them.  A patient has a very abnormal EKG or signs and symptoms of a heart attack or pneumonia and must be admitted to the hospital so you much call the hospital and give them a quick history so they are prepared for the patient and they don’t have to sit in the waiting room at the ER for hours.

1-2 days a week I get to be in the ER which is quite exciting…most of the time.  My first ER shift was not at all what I imagined…I mean for the first 1.5 hours there not a single patient showed up (there where patients in the ER who were there before my shift and had a different doctor).  When things got rolling there was not anything real interesting but that was alright because it allowed me time to learn where things are in the ER and how to use that charting system.  With patients in the ER I take a limited history about the reason they are reporting to the ER and present to the attending MD I work with and then we go see the patient together and then discuss and order labs and chart.  Unlike in the clinic setting in the ER there are medical residents who I get to work alongside and learn from as well.

So far I have completed 4 ER shifts.  I have seen a few cases of chest pain including heart attacks, asthma attacks, tendon injuries, drug seekers, drunks, a kleptomaniac, broken bones, high patients, a doctor with a needle stick injury, my first HIV+ patient, spinal bifida, and a patient coming into the ER at 1:30AM for a urinary pregnancy test.  These drunk patients are brought in my paramedics or even walk in themselves.  Most of them are frequent visitors of the ER so much so that the ER staff and paramedics alike know them by name and their preferred meal.  They come in sleep, sober up, and eat then get discharged only to be seen within the next couple of days again.

I have observed interventional radiology place a midline on a patient for venous access due to damaged superficial veins from track marks from IV heroin.  I assisted an orthopedic surgery resident on a reduction of displaced wrist fracture and had to hold the bones in place as he put the plaster splint in place.  I have been told I will be able to practice placing IV lines, catheters, and venous blood draws but as of yet have not had that experience.

I saved the best experience for last:  I SAVED MY FIRST LIFE!  A patient who was found unresponsive at his apartment was brought into ER the doctors, nurses, and students who where there before my shift got him stable and intubated.  During my shift he lost his pulse (coded) and myself and the other student there were called into perform CPR and let my tell you it was nerve wracking.  When my turn came I just did what I have practiced for 10 years and heard the AED say ‘compressions are good’ so I knew I was doing it right.  (Practicing for 10 years on a dummy is not the same as doing it on a real person and being the reason why their blood is moving).  When it was time to switch rescuers the attending physicians running the code said hold compressions right as we were switching and the patient had a palpable pulse and a heart rate of 106.  Shortly there after he was transferred to the ICU.  When my shift was almost over the nurse called up to the ICU and he was still alive at that time but had coded again.  I am not sure how much longer of a life I was able to offer this man as the odds of someone who codes multiple times making it to discharge are very low but in that moment I saved him.  With going into the profession I am this is just the first of many saves.

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Bek Moody

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finding joy in everything

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