Wednesday, September 12, 2007

So, it's been a while...

Well, I know it's been quite a while since my last post (which was featured in a Grand Rounds [only the second time I've submitted a post]). Things have been busy, I have been doing some steady 6-day weeks at the hospital and 5-6 day weeks at the gym. Am finishing up now, was in the ER today, have one more shift with the Hospitalists tomorrow as well as a night shift in the ER tomorrow and Saturday night. Then it's a few days of relaxation until my return to St. Andrews!

Couple interesting things I saw today:

86yo M on Coumadin bit his tongue 2 days ago, hasn't stopped bleeding since. Dr. M (female ER doc) puts a single 4-0 Vicryl (absorbable suture) in the hole, and applies some gauze. A little while later, patient has still not stopped bleeding, so we put some gel foam (little pieces soaked in thrombin/fibrin) to help the clotting...the bleeding slows, but the patient is poorly complaint (retired psychiatrist, Chinese - not much English) and it takes 3 things of gel foam and a small piece of surgicell to get it to stop. INR was only 2.0, btw.

64yo F originally from Northern Ireland on Vacation, forgot both her insulin refills and her glucometer. Felt horrible (very compliant in past, never forgot insulin shots ever); we thought it would be an easy script, but turns out her sugar is 501. We give her fluids and some insulin, but she doesn't understand what 501 is. Then I realize - in the UK we do blood sugars in mmol/L, while in the US its mg/dL. So, here is something for all you guys out there who encounter this problem: 1 mg/dL = 0.0555 mmol/L. So if you find her BS to be 501, tell her it's 27. If she tells you she's normally 5-8, that means she's normally 90-144. Hope that helps!

Today was also my last day shift in the always happens that I have to leave just when the nurses/techs/docs are getting used to me being around and are starting to feel more comfortable letting me talk to pt's, etc. Oh well, I've got years of that left.