A few thoughts from the last week of work

• I both love and hate the new work schedule. 12 six hours shifts are exhausting. Feels like all you do is work and sleep. But then we get four days off at the end of it…. which is pretty baller.
• Did a conscious sedation on a patient so we could relocate he mangled thumb. She had a pretty profound reaction to the propofol, taking a good 15 minutes to come back to acting like her normal self. At one point during her altered period she looks me dead in the eyes “Sir… you suck….balls!” Hilarious.
• I was expecting it to be quite in the ED over the labor day weekend. Instead it’s like all the nutter’s came out to play at once. We had 5 1:1′s going at once. It’s a 24 bed ED!
• I had one patient who was particular grumpy. I asked him why. Apparently it was raining pretty hard, so when the ambulance pulled up, they just laid on the horn until he opened the door. And when he did, the driver got on the PA and hollered “Get in the back of the truck!” So he did, and he was pissed about the lack of door service. No idea if it’s true or not.

And of course, the learning curve was steep as always. A couple of pearls and rules of the road from this past week

• “Two-fers are never sick, unless it’s poisoning, usually of the carbon monoxide variety” (A two-fer is a two for one patient room, usually two related kids in one patient room)
• Give a miligram of ativan to anyone with a complaint of seizure and alcohol is in anyway involved, even if not seizing.  Cuts down on repeat seizures, admissions, mortality & length of stay.
• PE’s and EKGs – S1Q3T3 is actually pretty rare. The most common EKG finding in PE is non specific T wave changes. Then, inversion of T waves in the anterior leads.

And finally, what’s an ED shift without a little humor. There is one attending who drinks a two liter of soda every shift. When he was off seeing another patient, the other attending dermabonded the cap shut (skin glue with the strength of rubber cement). After a few moments of struggling the first attending simply shouted “GOD DAMMIT” and stormed off, only to reappear 15 seconds later with an 11 blade scalpel in hand and quickly decapitated his bottle of soda.