Saturday, January 3, 2009

What a shift....

Wow. Moonlighting at another hospital today....what can I talks.

This hospital is a smaller community hospital in one of our rural towns. There is one physician on at all times, and between the hours of 12p to 12a, there is a PA on to help with flow during peak hours.

Today was incredibly busy, saw a great many patients, and some were pretty sick. One of which was a very debilitated old man who came in with a shortened, externally rotated lower extremity which was very obviously a hip fracture. He lived on his own, and had become increasingly confused over the past several months. I think that he must have fractured his hip the night before, as he was still wearing the same clothes from the previous day according to his family, and had an elevated creatinine. Along with a concomitant UTI. Can we say admission. It was a good femoral neck fracture with significant displacement. He'll be having surgery soon....

Also saw a patient who ended up being pretty sick. Had a an elderly female patient who had a syncopal event present primarily for evaluation of her shoulder, as she had fallen on her left side and sustained abrasions as well as pain and swelling at the sternoclavicular border. No SOB, No CP, No neurologic changes. Had some episodic dizziness after recovering from the syncopal event, but felt fine now with no pain outside of her clavicle. I explained to both her, and her family, that the clavicle pain and swelling was one thing, but more concerning was this isolated syncopal event. We needed to rule out more sinister causes for this. EKG demonstrated A-Fib, which the patient did NOT have a history of, exam demonstrated some skin tears, abrasions, and the above mentioned clavicle swelling and pain. Neuro exam was carefully done, and was benign. I ordered a head CT, and this demonstrated an acute SAH with bleeding in to the sylvian fissure and temporal lobe. I explained the significance of this to the family, and the need for urgent neurosurgical consultation. The nurse at this point, comes up to me concerned about his BP which was 95/55. I laughed and said that was perfect. I explained to her, that at this point, I would prefer a slight hypotension, as long as she was perfusing well.

Anyway, add to that, the diverticulitis patient, the 2 year old that needed periorbital suturing, the two chest wall traumas (non penetrating)...and this PA is done tired.

Now I have to go deal with a drug seeker......yay....(rolls eyes)

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