Intubation 101 and Reiters Syndrome...
They weren't kidding when they said that the learning curve is steep during internship...it's exponential! I can't believe how much stuff I'm seeing and doing every week...I feel like it was years ago since we were in orientation and I still can't believe how much more I have to learn! I was on call on Friday night and Sunday. The black cloud descended as expected on Friday and I got about 30mins sleep tops (lots of OB...of course!...and an alcoholic in withdrawl in the ICU that wouldn't behave himself and ended up on hard restraints and 30mg/hr ativan...and was still conscious somehow!). At around 3am, as I stumbled up to the 3rd floor for an OB triage page, I heard the dreaded "rapid response" page overhead, and ran as fast as I could to the ICU. A COPDer had just come up from the ED, and they had "thought about" intubating her while she was down there, but decided against it. By the time she got upstairs, she was gasping for air, her BP was through the roof, and she was getting hypoxic. The ER doc came and let me intubate her. It was sweet...only took me 3 tries...poor lady! She got seriously hypoxic while I learned how to intubate the esophagus successfully...twice! Let me tell you...it's pretty nerve-racking having 2 respiratory techs, 3 nurses, an ER doc and your senior all standing there with their eyes trained on you, waiting for your slow, unsteady hands to get the blasted ETT in place so that everyone else can do their jobs and so the patient can actually do a little thing we like to call BREATH! Unfortunately, intubating a real like human being isn't as easy as these guys:
It's SO freaking hard to get the blade in place- I can't believe how much force you have to use to get a good view of the cords. I was shaking and sweating (I felt like Jon! hehehehe) and getting a serious ulcer, but the ER doc was really cool and kept letting me try and was so patient with me. And it finally worked, and as the patient started to get good oxygen, I collapsed back against the wall and decided it would be a good idea for me to start breathing again, too!! All in all, it was pretty sweet!
Today in clinic, I saw a guy who came in with a UTI. He was a new pt, so I got his full history, and found out he has a h/o an STD, has "chronic conjunctivitis" and has a lot of joint pain. I was like...HEEEEEEEY, I know what's wrong with you...you can't see, pee, or climb a tree!! I actually get to diagnose a zebra! It was totally Reiter's syndrome!!!
Of course, after making the Dx, I had absolutely no clue what to do with him, but that's besides the point! I was all giddy as I presented to Dr. K, who was just laughing at me and shaking his head and told me it's never a good sign for a patient when their doctor gets excited. :o) He was pretty interested, though, and said it would probably be a once in a career kind of thing to Dx since it's so rare. So if any of you want to come and gawk at the patient with me, he'll be following up in 2 weeks. :o)
It's SO freaking hard to get the blade in place- I can't believe how much force you have to use to get a good view of the cords. I was shaking and sweating (I felt like Jon! hehehehe) and getting a serious ulcer, but the ER doc was really cool and kept letting me try and was so patient with me. And it finally worked, and as the patient started to get good oxygen, I collapsed back against the wall and decided it would be a good idea for me to start breathing again, too!! All in all, it was pretty sweet!
Today in clinic, I saw a guy who came in with a UTI. He was a new pt, so I got his full history, and found out he has a h/o an STD, has "chronic conjunctivitis" and has a lot of joint pain. I was like...HEEEEEEEY, I know what's wrong with you...you can't see, pee, or climb a tree!! I actually get to diagnose a zebra! It was totally Reiter's syndrome!!!
Of course, after making the Dx, I had absolutely no clue what to do with him, but that's besides the point! I was all giddy as I presented to Dr. K, who was just laughing at me and shaking his head and told me it's never a good sign for a patient when their doctor gets excited. :o) He was pretty interested, though, and said it would probably be a once in a career kind of thing to Dx since it's so rare. So if any of you want to come and gawk at the patient with me, he'll be following up in 2 weeks. :o)
Write when you can, guys! It's great to hear what everyone is doing! Can't wait to see you all at block end next week!
P.S. Dr. C (surgery) is AWESOME! All we do is breast CA surgeries, but it's so interesting and she is way cool! And the schedule ain't bad, either!
1 comment:
Yeah, Reiters is DEFINATELY the first thing I thought of too when Nicole was telling me this story. I know you guys all probably knew the Dx too, right after she said he had a UTI. Actually, it would've been at that point where I probably would've been pleased with a Dx of UTI, given him some Abx, forgot to ask any PMHx, and kicked him in the rear on the way out, just for good measure, and to make sure that he scheduled all future follow-ups with someone else (who CAN identify Reiter's).
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