Jump to content

That abscess made me woozy!


Recommended Posts

Okay everyone I have a confession!

 

I recently got accepted to my top choice PA program and am super excited. I start in August, but I'm kind of stressing over one thing: abscesses!

 

So I've been an EMT out in the field for 3 years, spent quite a bit of time in ER's and have seen a lot. I haven't ever had a situation where I felt woozy or faint due to what I was seeing. However, when I began to work in an urgent care setting a year ago, I found my weakness. Obviously, as you might assume so by now, was an abscess. Almost every time (there were a few I was fine with because they weren't too bad) I just felt sick to my stomach and as if I was about to faint. It became my mission to get through one whole abscess I&D and packing procedure feeling 100% With time I got a lot better but I still wouldn't say "good." During all of this I was just assisting the PA with these procedures. In a few years I will be the PA!

 

Everyone I spoke to about it keeps telling me it's normal, and I will overcome it with more experience. I'm just so scared to look incompetent when faced with it again, even as a student.

 

Anyone gone through something similar? Tips? Am I doomed?

 

 

Sent from my iPhone using Tapatalk

Link to comment
Share on other sites

I work in UC as a MA and I don't share the same experience with abscess...I actually enjoy watching I&D (i usually leave the room when the provider begins the packing)....BUT...I gag a little when I do a get a whiff of someone's urine when they're having a raging UTI.

 

 

 

...and I had my fair share of cleaning up c-diff stools. bleh.

 

 

weird I know.

Link to comment
Share on other sites

So. Yeah I used to avoid them but as dumb as it may sound it is one of the most satisfying procedures you can do. It's a little gross but it's the one diagnosis (given right circumstance) that you can see someone and make them feel ten times better before they leave. "Doc is it gonna hurt?"

"Yes. But then you will feel SO much better".

"Well at least she's honest!"

(I'm about to cut you hello?)

 

You open the abscess get good results and a lot of the times the patients still have pain but feel a big improvement. I ask "do you feel a difference in all the pressure you were feeling?" It's one of the few times you hear thank you thank you thank you

 

So all in all after you get through the first twenty or so you try to convince the patient to go through with it when appropriate. Dude. You're going to get so much better so much faster.

 

Watch as many as you can then do as many as you can. Sometimes I'm not in the mood and not everyone is nice and if they are a "grabber" I ask for a tech to help settle them. Mr or Ms patient the natural instinct is to jump and I don't want you to get stuck more than you have to. Do you want X to help settle your extremity down? I cannot STAND a patient grabbing my arm or hand or any part of me. Ever.

 

You'll change your mind. You just have to get over the stigma like I did.

 

I worked as an EMT two years before school. Try to do the procedures that makes you feel most uncomfortable so you'll get over that "yuck!"

 

I used to avoid pelvics and abscesses and lacerations and now sometimes I just get in the mood for them haha! I would rather see a nasty pelvic and Dx PID instead of waiting four hours for the usual abdominal pain complaint with CT (if it fits duh)

 

You're actually making a big difference to someone right then.

 

You'll do fine. Everyone goes through growing pains.

 

Gown up if it makes you feel less grows. No harm in that.

 

 

Sent from my iPhone using Tapatalk

Link to comment
Share on other sites

I agree with the other folks that the more you do it the easier it will be. I remember being fresh out of respiratory school and getting horribly nauseated on a nasty trauma and on a couple of other patients. I'm not exaggerating but at this point in my career I have left my breakfast for a horrible trauma and came back and finished it without thinking twice. The ER's I worked in broke me in fast, and I think that's the best way. Smells will get you before anything I see...so I don't know if it helps but avoid sniffing the nasty stuff haha. I've ran into a room grabbed a mask and just quickly slapped a bit of hand sanitizer on the outside of the mask. The alcohol smell beats the nasty stuff in some cases haha.

 

 

Sent from my iPhone using Tapatalk

Link to comment
Share on other sites

Just wait until it's a peri-rectal abscess!  ;)  Kidding aside - you will probably be fine.  Your approach is sound. 

 

One word of caution:  If your ears start ringing, get out of the room ASAP or crouch in the corner.   Passing out on the patient can cause problems.  

Link to comment
Share on other sites

This post reminded me when I was trying to pick my career so I started shadowing a couple critical care PAs. We were in the burn ICU and they were getting ready to put in a central line through the femoral site. The patient kept jerking her leg up and once the site went in my ears were ringing, felt lightheaded, had to sit down. It was awful and so embarrassing. Luckily, I was met with encouragement and I got past that vaso vagal feelings after shadowing a bunch more.

Link to comment
Share on other sites

I think that it is different when you are performing the procedure yourself. And as a student, you will!

 

Abscesses also tend to be one of my least favorite procedures. 

 

I once had a preceptor who MADE me get up close to a diabetic foot ulcer so that I knew what gangrene smelled like. That was a close one. I've found that clenching and unclenching your fists can be helpful. But like other posters said, if you really feel like you are going to syncopize, get out of the room!

Link to comment
Share on other sites

Had an I&D today. Axillary abscess about 8cm and HELLA fluctuant. Incised it and copious purulent discharge. Looked like melted pistachio ice cream.

 

That wasn't the sick part. The pt was incontinent and had that pee+pee deodorizer smell (you guys know what I'm talking about) and what I presume was a full diaper. It filled the room with that aroma.

 

Hours after the pt left, I was asking my MA "do I smell like pee?" (she assisted me with the procedure) and she said "No I thought it was ME!" we asked a third party to smell us both and she said we smelled fine. It later donned on us that it was burnt into our frickin nostrils... ????[emoji40]

 

Ahhh good times...good times...

 

Sent from my SAMSUNG-SM-G870A using Tapatalk

Link to comment
Share on other sites

  • Administrator

Keep a little can of Vicks Vapo Rub around for the stenches and dab it under your nose.

So, first time we go to a cadaver lab in my A&P class at a local CC, and I load my mustache up with Vicks.  Works great!  Then one of the pre-nursing students turns to me about 5 minutes in and hisses to me, "Go away! Your Vicks is clearing up my congestion!"

 

Whoops.  Unintended consequences...

Link to comment
Share on other sites

Keep a little can of Vicks Vapo Rub around for the stenches and dab it under your nose. Worst is when it isn't a wound, its the whole patient. I've taken care of people who smelled like they drove a manure truck into a pile of burning goat carcasses.

Oh smells I tell you, gotta love them. Definitely keeping this in mind! Thank you

Link to comment
Share on other sites

Had an I&D today. Axillary abscess about 8cm and HELLA fluctuant. Incised it and copious purulent discharge. Looked like melted pistachio ice cream.

 

That wasn't the sick part. The pt was incontinent and had that pee+pee deodorizer smell (you guys know what I'm talking about) and what I presume was a full diaper. It filled the room with that aroma.

 

Hours after the pt left, I was asking my MA "do I smell like pee?" (she assisted me with the procedure) and she said "No I thought it was ME!" we asked a third party to smell us both and she said we smelled fine. It later donned on us that it was burnt into our frickin nostrils... [emoji40][emoji40]

 

Ahhh good times...good times...

 

Sent from my SAMSUNG-SM-G870A using Tapatalk

Oh my goodness! The whole time I was reading this, my mind was just repetitively picturing melted pistachio ice cream oozing out of an abscess, chunks and all! [emoji85]

Link to comment
Share on other sites

The smell of vomit gets me. When I worked as an RT, nothing horrified me more than a patient coming in intubated with one of the cloth/velcro type tube holders soaked in vomit. AHHH! 

 

There was the time I was suctioning a gaping infected stoma in a patients neck, and leaned over them to grab something and got a hot, wet, infected cough straight out of the stoma onto the side of my head. But still, that didn't bother me, it's the vomit. Blegh

Link to comment
Share on other sites

One of my favorite moments in inpatient/ICU rotations was a guy who had a trach due to long term intubation following pancreatitis which led to excessive vomiting and therefore he couldn't drink his EtOH, this led to EtOH w/d, hemothorax (sustained when he fell during DT seizures), and then sepsis from Vent PNA - he kept coughing and they went to suction out the trach.  I don't recall if I was told to stand at the foot of the bed or not, but that's where I took up residence in this story.  At any rate, I knew he had propensity to shoot mucous across the room in large quantities.  It just so happened that the suction catheter stimulated his cough reflex and here came a huge wad of mucous right at my face.  I dodged it matrix style and watched it land with an audible "splat" on the floor.  After gagging a bunch I cleaned it up.  Everybody got a laugh out of that one.

Link to comment
Share on other sites

There was the time I was suctioning a gaping infected stoma in a patients neck, and leaned over them to grab something and got a hot, wet, infected cough straight out of the stoma onto the side of my head. But still, that didn't bother me, it's the vomit. Blegh

I've been sprayed too, although yours sounds worse. I also was an RT (student now). I thought I was fairly immune to the nasty, until the first time I saw maggots crawl out of a stoma. [emoji33]
Link to comment
Share on other sites

I had an abscess shake me before I began PA school, too. It was the smell -- I couldn't stop gagging. I should have noticed when the MD masked up before I&D. 200 ccs of pus later, he was laughing at me in the hallway as nurses put out filters full of ground coffee to buffer the smell. Made me question myself, too. But then I saw another doc leave a C diff case, vomit casually, and head straight back in. It's OK. Everyone's got their "thing."

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More