The Drunkest Guy Yet

Last night was an interesting shift. 18 hours, two calls, which isn't bad. The first one was no big deal, (moderate concussion, easy transport, cooperative patient).
The SECOND patient was a whole different story. 3 am is never a good time to be hauled out of bed, and we knew it wasn't going to be an easy call when we could smell the alcohol from OUTSIDE the room. The patient was (sorta) conscious, but he thought it was Halloween, he kept giggling, and he repeatedly climbed out of the stairchair because "seatbelts dont belong on chairs!!!" He hadn't vomited at all, which was a blessing from a messiness standpoint, but I have no idea how he managed to drink so much and not get sick. His friends estimated that he'd had 10-15 shots in the preceeding hour, and must have JUST stopped drinking before the campus cops found him.
Once on the ambulance, he repeatedly attempted to grab my breasts while I took his blood pressure. Who knew that "no, these aren't for you" actually WORKS as a deterrant? Then he passed out, which made things easier.
Hope he's ok...KNOW he won't know better.

Hyacinth

I would just like to state, for the record, that hyacinths smell AMAZING...and that I got some at Trader Joes for 2 bucks. WHEEEEE!!!

Unexpectedly Emergent

Today I had a lovely pt. on contact precautions for MRSA colonization (no active infection), and got to follow her to the lab where they were testing her brand new internal defibrillator. What this involves is quite nerve-wracking. They sedate the patient, pace her on the T-wave, which sends her into V-fib, and then WAIT and see if the defibrillator can kick her back out of it into sinus. This was the SECOND test. The day before the test had failed, and they had to use the external paddles. This time, after ten heart-stopping seconds, she cardioverted, and all was well.
The second drama in the day unfolded about 4 minutes after I left the lab: one of my classmates came running up to say that a girl in my carpool had collapsed in the hallway, unconsious, and was being taken to the ER. Needless to say, the two of us in the carpool with her ran down to the ER, and stayed there until her discharge 4 hours later. Diagnosis? Vaso-vagal syncopy, with mild bump on the head. Basically, she stood still in a freezing room for four hours, and hadn't eaten in 6. When she walked OUT of the cath lab into the hallway, which was VERY warm, and her blood started moving again, she passed out and bumped her head. All is well, but it made for QUITE an exciting day. The best part was taking the EKG electrodes off her every 20 minutes so that she could go to the bathroom, because they had her IV running in so fast.

SPU

Today I was sent to "observe" in the Short Procedure Unit. In other hospitals this is known as the "Same Day Surgery" unit. We (me and my counterpart from the other clinical group) spent most of the morning in the Intake part of the unit, bringing patients back, orienting them to the unit, helping get them into surgical gowns, caps, sock-with-treads, et cet, then taking vital signs, and completing intake assessments. We were only TECHNICALLY supposed to be OBSERVERS, but the nurses were busy, and pretty soon we were doing 2/3 of the intakes, while the nurses were doing the urine pregnancy tests, starting IVs, giving meds, and charting. This was fine with us, as we had something to do.
The remainder of the day we went to the POST surgical area, which is also known as Recovery II. Recovery I is the PACU, where patients are brought out of anesthesia, and vitals are assured to be stable. If the patient is going to be staying, they then are admitted to a floor. If, however, they've had a tonsillectomy, or a tendon surgery, or a fixation of a broken arm, or something, often they come back down to the SPU, and stay there until they are ok to leave- not nauseous, fully consious, pain controlled, feeling ok. We helped dress people, complete "discharge teaching", brought warm blankets and snacks, and basically did all those little things that are really nice, but nobody ever gets time to do for the patients. We got profusely thanked about 40 times.
If only our patients up on the Cardiology unit would be so grateful... :-p

Clinic

Spent last night helping at a clinic downtown for non-English speakers. Our responsibilities included doing all of the vital signs and "triage" to ready patients for their appointments, and we also got to go in with the nurse practitioners and see what THEY did. The hands-down coolest part of the evening was when we got to watch the doc on duty do an ultrasound on a patient's thyroid. The patient had a VERY large goiter, something I've never seen before, with necrosis and some liquefaction in the center. The doc walked us through everything he was doing, all the abnormalities. I'm not sure this was for OUR sake, or for the sake of the two COMPLETELY USELESS medical students. They didn't know ANY anatomy, and just stood there like idiots.
It was pretty great, altogether.

Echo

Echocardiograms are COOL. I just had to say it. I dropped my detoxing patient off for his Echo, and the tech invited me to stay, and showed me what all of the views were for, what to look for in the heart, and even gave me memorization techniques for visualizing cardiac anatomy. This came in REALLY handy when I was able to inform the doc that there had been abnormal findings in the Echo consistant with amyloidosis. As this was an incidental finding, not something they were looking for, I was worried that it would fall through the cracks.
Not that it would matter to my patient, on his latest of many strokes brought on by completely uncontrolled HTN, seizures, and cocaine use. He HAS insurance, but he chooses not to purchase his meds, as the 4 dollar scrip cost would cut into his cocaine budget.
And he smelled like a sewer, and refused my repeated attempts to clean him up. Honestly, I was going to be nice, and clean him, but Noooooo. That was just NOT cool with him. Instead, he wanted a second lunch, so that his wife could eat too, without buying food for herself. "nope!" i said, gave him a sub-Q injection, and left the room. With the side rail up, call bell within reach, like a good nursing student.

Nightshift

Sometimes being an observer sucks. Three calls last night, ALL of them intoxicated underaged idiots. Honestly, I'd like to do a presentation to the freshmen at Orientation entitled "Please stop before you vomit: how to not be a tool when you drink". Or, if that's just TOO MUCH TO ASK, I wish they'd start drinking at 3 or 4 pm, so that the calls to evaluate drunken kids would come in at 10 pm instead of 3 am when we're all tucked into bed at the squadroom.
One interesting fact is that the reaction to being caught usually falls out along gender lines: the girls are the ones who inevitably start sobbing, say their parents will be SO MAD, and slur incoherent questions about whether they're "going to get in trouble". Sweetie, you were in trouble BEFORE we got here. Yes, you ARE going to get written up if you're so drunk they called us. Its not like the campus cops are TRYING to get these kids in trouble. If they "catch" somebody, it's usually because theyre falling all over the pavement.
As a result of this terribly unsatisfying drunkenness, no trauma, and i barely slept.