02 February 2009

My day at BTGH-EC

The first thing you really notice is how much trouble you have to go through to get to Ben Taub (from Baylor). Down a ramp, then up a floor in an elevator. Having card access to Ben Taub rocks.

*Beep* [Light flashes green + almost imperceptible click of the door lock]. So satisfying. The next thing you notice is the old BCM logo plastered along the corridor. What a horrendously ugly logo.

Ugh. Are you srs? Yeah, they're serial. The new logo is awesome though - simple, with a great color scheme. Midst the quiet, the third thing you notice before you get to the emergency center is the smell. Faint hints of nausea, vomiting, sterility, and cleaning fluid, all mixed in one.

This is the first year they started this program, and I had the first shift evar - Midnight to 4AM. I had done ER shifts before (at Medical Center of Plano). 12 hour shifts, and I got to see almost nothing - a few drug overdoses, alcoholics, maybe a case of acute angina. 4 hours at a Level 1 facility is far far different. Three GSWs, a few stabbing victims. Ambulances were coming in almost every 30 minutes and a Code 3, almost every hour. Crazy! We had "heard" of Code 3 (full lights and sirens) in Plano, but I never got to see one.

Ben Taub runs at 150% capacity and to put things into perspective - it's a bit bigger than the ER at County General.* But man, Houston is so ghetto. In the 4 hours that I was there, there were 2 GSWs, a few stabbings, and one person that got run over (maliciously..).

More importantly, I got to start a few IVs. I feel sorry for my first IV patient though. I haven't treated patients in a long time and it's really something to hear "Ok, you watch this one, and the next one is yours." 10 minutes later, the nurse was handing me a chart to call a patient back to the IV area - NVD symptoms, and I was looking at her and I felt a little sorry for the short period of pain that was coming.

It's good to just stick in the lancet and get it over with. I was going slow, so she was squirming in pain the entire time. The nurse told me to stick it in there and flip the catheter forward. I have to admit, it was satisfying seeing that flash of blood** through the proximal portion of the lancet, indicating a good cannulation. Those NEJM videos really do no justice to the initial difficulty of starting an IV.

So many things can go wrong. Put on some gloves, take out the J-loop, flush it with saline, lay it on a piece of gauze, take out the 20 guage, unsheath the cap, loosen the catheter, lay it on a piece of gauze, take out an alcohol pad, identify a vein, rub the area with alcohol, wait for the vein to appear or be able to feel it, find a straight segment in the vein (or make one by pulling on the skin), insert the lancet along the straight segment, keep inserting until you see the flash of blood, push the lancet 1-2mm along the vein, flick the catheter forward, compress the vein proximally, affix the J loop to the vein, flush with saline to confirm a good cannulation --> ending steps.

It takes practice. The great thing about it is, there's a clinical/basic science reason to each one of these steps and you can think about it all you want, but until you really start doing the procedure, you have no idea what they *really* are.

The subsequent IVs were better and I was promised an arterial stick next time. Smaller and deeper vessels.

I also learned how to do an EKG and a quick interpretation of it. The attendings kick ass. A 20 minute explanation and she doesn't even know who I am. Which, if you think about it, is pretty cool, in that they're willing to teach anyone.

My next shift is Saturday early morning, midnight to 4am. Bring it.

*: If you don't know what I'm talking about, google it. Then watch all 15 seasons.
**: Serial-killer-ish. "Do no harm" becomes "Do more good than harm".

1 comment:

ming said...

looks like you just miss me. i'm night call fri night.