As part of a pre-hospital medicine elective, I did a 10-hour shift ambulance ride-along with a couple of paramedics. I took this elective because I wanted to get a better idea of what happens with patients before they arrive in the emergency room, but the experience ended up teaching me more about the general job duties and perspectives of a paramedic.
My shift started at 2:30 pm and went to 12:30 am. It was a rather slow night - good that few people were getting hurt, but unfortunate for me since it made for a boring experience. We didn't get our first call until 5:30. Over the course of the night, we only had 6 calls total, 4 of which were Code 10 (sirens blaring). My classmates who also did a ride-along had vastly different experiences: one was doing CPR in the back of the ambulance while a patient was having a heart attack.
During all that down time, the two paramedics who I was shadowing talked a lot about their various interactions with nurses and doctors. I found it interesting that they grouped the quality of their interactions with nurses according to the hospital (apparently each hospital has its own "culture"), but the quality of their interactions with doctors was based more on individual personality rather than a particular hospital's culture. If I got anything else out of this elective, my two paramedic friends reinforced the interdisciplinary teamwork lessons that were drilled into us last semester: doctors are one component of a medical team, and patient care is maximized when the team works well together.
I enjoyed my experience overall, and would recommend this elective to someone interested in emergency medicine, but I do wish the ride-along could have been a bit more exciting.
Sunday, February 28, 2010
Wednesday, February 24, 2010
Intubation night
The Emergency Medicine Interest Group (EMIG) hosted intubation night on Monday. We were up in the anatomy lab practicing on cadavers how to intubate a patient, which just means sticking a tube down the patient's trachea to start artificial ventilation. I have seen this done many times during my experiences in the ER, so it was especially rewarding to learn the how's and why's of intubation.
The emergency medicine residents taught us how to use an instrument that pushes the tongue out of the way and has a light at the end of it to see down the throat and pull up on the trachea to allow passage of the tube. This is a metal instrument, so it's actually difficult to do without chipping teeth. Then, a small balloon is inflated to secure the tube in place, and the patient is ventilated with an air mask.
If the patient (or in the case, cadaver) was intubated correctly, the chest will rise with ventilation. The tricky part about intubation is getting the tube into the trachea rather than the esophagus. In the ER, the doctors verify that the tube was placed correctly by listening with a stethoscope to breathing sounds in both the chest and stomach: breathing sounds in the stomach indicates that the tube is placed in the esophagus, which is obviously a bad thing. Standard procedure in the ER is also to take a quick x-ray to make sure the tube is placed correctly. If the tube is inserted too far, it could go down the right or left bronchus and supply air to only one lung. That's also an obvious situation to avoid and another reason why doctors listen for breathing sounds on both sides.
I suppose the chances are rather slim that I'll actually be able to do this on a real patient anytime soon, but it's something to look forward to.
The emergency medicine residents taught us how to use an instrument that pushes the tongue out of the way and has a light at the end of it to see down the throat and pull up on the trachea to allow passage of the tube. This is a metal instrument, so it's actually difficult to do without chipping teeth. Then, a small balloon is inflated to secure the tube in place, and the patient is ventilated with an air mask.
If the patient (or in the case, cadaver) was intubated correctly, the chest will rise with ventilation. The tricky part about intubation is getting the tube into the trachea rather than the esophagus. In the ER, the doctors verify that the tube was placed correctly by listening with a stethoscope to breathing sounds in both the chest and stomach: breathing sounds in the stomach indicates that the tube is placed in the esophagus, which is obviously a bad thing. Standard procedure in the ER is also to take a quick x-ray to make sure the tube is placed correctly. If the tube is inserted too far, it could go down the right or left bronchus and supply air to only one lung. That's also an obvious situation to avoid and another reason why doctors listen for breathing sounds on both sides.
I suppose the chances are rather slim that I'll actually be able to do this on a real patient anytime soon, but it's something to look forward to.
Monday, February 8, 2010
Earning it
This falls under the category of something that all medical students know but don't want to think about. (http://xkcd.com/699/)
Tuesday, February 2, 2010
Aortic valve replacement lab
The Surgical Society hosted an event that brought in a number of cardiothoracic surgeons to teach a group of about a dozen medical students the basics of aortic valve replacement. We worked up in the anatomy lab with one pig heart and one CT surgeon for three students, plus several other CT surgeons floating around the room who were apparently there just to play around with the hearts and have fun.
The surgeon teaching my group first pimped us on heart anatomy then walked us through the transplant procedure step-by-step. The three of us took turns playing "surgeon" while the real surgeon helped us with the technical details (e.g. where to cut and where not to cut, how to position the sutures, etc...) and by explaining why we were doing what we were doing. Whenever one of us made a mistake, our teacher yelled at us, "You killed your patient!" It's a good thing we were only working on a dead pig's heart.
Seeing how all the pieces fit together physically, in three dimensions, helped me wrap my brain around how it's even possible to replace a living breathing patient's aortic valve. It truly is amazing.
The surgeon teaching my group first pimped us on heart anatomy then walked us through the transplant procedure step-by-step. The three of us took turns playing "surgeon" while the real surgeon helped us with the technical details (e.g. where to cut and where not to cut, how to position the sutures, etc...) and by explaining why we were doing what we were doing. Whenever one of us made a mistake, our teacher yelled at us, "You killed your patient!" It's a good thing we were only working on a dead pig's heart.
Seeing how all the pieces fit together physically, in three dimensions, helped me wrap my brain around how it's even possible to replace a living breathing patient's aortic valve. It truly is amazing.
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