Week 6 - Jenny Puetzer

This week I spent a day shadowing in the emergency department. I spent two years as a volunteer emergency medicine technician (EMT), so it was interesting to see what goes on in the ER after the EMTs and paramedics leave and how the doctors use what they are told from the EMTs. I was paired up with a first year resident who had only been practicing for a month. I think this made the experience much more interesting since it was like I was learning with her. It was definitely a slower day then if I was paired with a more experienced resident, but I was able to actually help her with certain things and see the whole process of diagnosing a patient all the way through. The most interesting patient we had was a 61 year old man who came in as a trauma one because he had fallen and we were told had a laceration on his head. As soon as he rolled in to the ER a team of doctors went to work on getting all his information and doing a quick examination. We found that he did not have a laceration on his head, just a very large hematoma. He had a cut up back, bruised hip and possibly broken collar bone also. As soon as the examination was over, the resident and I took him down for a CT and X-rays. We got to stand in the room as he got the CT and X-rays done and got the results instantaneously. He luckily had no damage to his skull, neck, or hips, but did have a broken collar bone. While we were at X-ray the patient’s breathing became very labored and loud. This raised the concern that he may have a collapsed lung. We rushed him back to the ER for more examination and to rule out the collapsed lung. The patient wasn’t completely coherent so it was very difficult to get accurate information from him, however we learned that he has COPD and he claimed to have just gotten diagnosed two weeks ago with pneumonia. This eased the doctor’s mind about his breathing and they let him rest some more in hopes of it improving. However, a little bit later his blood pressure dropped extremely low. At first it was believed this was because of the morphine, so fluids were pumped. However, with time his blood pressure rose slightly and then crashed again. The patient continued to look worse and worse throughout the day. The doctors were afraid they had missed a bleed somewhere in his abdomen so the resident and I rushed him down to CT again for a full body scan. No bleeds were found leaving the doctors perplexed on what could be the cause. By the end of the day a friend of the family came to visit and we learned that he had actually just gotten out of the hospital 3 days earlier after a 5 month stay and had a whole host of things wrong with him. The patient was admitted for the night and continued observation. This was a very interesting case to work on and see how the doctors worked through all of his aliments to try and diagnosis him. It was also very interesting to see all the CT and X-rays results first hand.

Aside from shadowing in the ER, the rest of the week was more of the normal schedule of seeing patients with Dr. Rodeo, grand rounds for arthroscopy, and many orthopedic surgeries. I think one of my favorite things to do while here for the summer is to see patients with Dr. Rodeo. It is very interesting seeing firsthand how orthopedic problems affect so many people from the super athletes to the degenerative disease aged patients. It is also very touching to see how many younger patients, under the age of 20, have very serious orthopedic problems needing surgeries that will only delay the inevitable total knee replacement. Seeing these patients and what they must deal with on a day to day basis will help to motivate me the rest of my career and I really appreciate the opportunity.