Arrive at work, walk into A/B pod, and pick out a computer for the day. I make sure to say hi to the night team and ask how their night went. Another busy one,
and they’re happy to see me.
I pull up the tracking board to see which patients need to be seen. There’s one ready to go, so I look through the chart—elderly, abdominal pain, no recent CT scan. I head in to see him. In addition to my history and physical I do a quick ultrasound checking his aorta, kidneys and gallbladder.
I finish seeing him and dash back to my workstation to put in some orders and before joining morning sign out.
“Resus to A7, 5 minutes out.”
Charge nurse walks over. “It’s a 35 yo male. Cardiac arrest. Found down by family with an unknown downtime. ACLS for the last 45 minutes.” Our attending, 2nd year, intern and I don our PPE on and walk over. The 2nd year brings the airway cart and gets ready to intubate. The 1st year brings the ultrasound and the crash central line cart. I get the team ready.
The patient arrives with the LUCAS in place and a king airway. The second year intubates him. We continue ACLS. We have no history. EMS was called by a friend who stated that he just passed out while watching TV. On the next pulse check, the patient is asystolic and without cardiac activity on ultrasound. Unfortunately, this patient didn't make it and now I must go break the news to his family. Was it drug overdose, a deadly arrhythmia from WPW, poisoning?
A nurse asks me to evaluate the 84-year-old lady in bed one whose heart rate is 40. I walk to her bedside thinking about the scenarios. Stable vs unstable. What
will I do first? Does she have a blood pressure? I find her sitting up in bed talking to her daughter. Her blood pressure is normal and she tells me she was
feeling fine but her PCP sent her here because her heart was "beating too slow." I look carefully at her EKG and she has a complete heart block. The nurses have already placed pacer pads on her chest—just in case her pressures start to drop. I'm glad she's stable and I can leave her bedside to call cardiology so that they can take her upstairs and arrange for a pacemaker placement.
I see many more patients including a 16-week pregnant female with vaginal bleeding, a 65 year old male with unstable angina, and a 28 year old male with a complex finger laceration. I supervise our intern performing a central line on his patient who is now requiring pressors for septic shock and do some quick teaching with our med student on which pressors we are selecting for this patient and why.
For each encounter I follow the same mantra: Stable or unstable? What are the life-threatening conditions that this person may have that are consistent with
their complaints? What tests or studies that will help me determine the problem? Do I need any consultants immediately?
Overhead I hear “Cat 1 trauma 5 min out”. I excuse myself from examining another patient and dash over to the trauma bay. My pager goes off: “45 year old female, restrained driver of a high speed MVC, tachycardic, hypotensive.”
Our second year gowns up and is at the head of the bed to assess the patient’s airway while I stand at the foot of the bed as team leader. Our surgery peers arrive to perform the head to toe physical exam and help place orders. The patient is alert but very anxious. Her blood pressures are dangerously low—even with IV fluids running. She is complaining of severe abdominal pain. On our exam, we find bruising from her seatbelt strap. Her FAST ultrasound shows free fluid in her abdomen. I ask the pharmacist to draw up some pain medications and ask the nursing team to start a type O neg blood transfusion. I talk with the trauma surgeon and we agree she should go immediately to the OR for an exploratory laparotomy.
||The evening residents (my relief!) are starting to trickle in and I am so happy tosee them.
||Sign out for team AB is announced overhead. Everyone gathers and we talk about our patients who have tests that are still pending. I’m so grateful for the
culture of signout—everyone is eager to take over your patients so you can get home and recharge.
My charting is finished and it's time to head out. Some of my coworkers are biking to a nearby brewery after work and invited me. I’m not sure if I’m going to
join them or head to the gym instead before getting home to spend time with my loved ones and get some well deserved rest.