the cableguy Posted November 6, 2009 Share Posted November 6, 2009 Just venting... This is my first weekend of solo ER call. Well, not totally solo. My MD backup has 20 minutes to be in if I call him, but that is an ETERNITY in ER time. I've been working in the ER for two months now, during the day, with MD backup in the facility if I need it. Tonight at 5, though, I'm on my own. I'd be lying if I said I wasn't a little nervous. I love the ER and the almost immediate gratification that you get from focusing on one issue and, hopefully, making people feel better (even if its just treating their pain). Most of the things that come through the ED are pretty benign and I feel comfortable handling them. Its the TRUE emergencies that make me question my sanity for taking this job. You know, when rapid clinical decisions need to be made immediately or else someone will die. I eventually want to be capable of handling these types of situations but I know that will probably take years. I guess I'll hold on tight in the mean time and hope all goes well... Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 6, 2009 Moderator Share Posted November 6, 2009 oh yeah - I wanna be you!!!!!111 after having done a number of different jobs over the past 7 years I am thinking the ER is where I belong so that I can be the decision maker (to old to go back to med school) in some small out of the way ER... problem is what you are descrbing scares the healll out of me! So I will keep up on your thread and see what wise old crusty ER PA's have to say..... What state are you in (other then the state of panic??) Good luck! (and remember you likely know a lot more then you think!! - and in you spare time pick up a copy of the book http://litmed.med.nyu.edu/Annotation?action=view&annid=11748 "here just trying to save a few lives" I am 3/4 through it and thinking oh crap why do I want to do er.... Link to comment Share on other sites More sharing options...
the cableguy Posted November 6, 2009 Author Share Posted November 6, 2009 What state are you in (other then the state of panic??) .... North East Washington State, about 30 miles from the Canadian border. Incredibly beautiful country. Our facility is actually very nice for an extremely rural ER. We have lab and radiology departments, including a 16 slice CT scanner. No access to FAST in ER though. DPL anyone? I have never intubated a real person nor used a difibrillator... Link to comment Share on other sites More sharing options...
dfwpa Posted November 6, 2009 Share Posted November 6, 2009 If you feel comfortable w/ PALS and ACLS you can get by until your SP arrives 20 min later. Just remember your basics and think ahead....if there's any possibility that a pt might go downhill, make sure you get a few large bore IVs in way ahead of time...that'll make things like seizures much easier to deal with. Link to comment Share on other sites More sharing options...
Evan Posted November 6, 2009 Share Posted November 6, 2009 I have never intubated a real person nor used a difibrillator... You should be alright... I did my BLS re-cert this year and found out that airway and breathing were overrated compared with circulation... Difibs are all automated now... "... a chimpanzee and two trainees could run 'er..." Please ingore my posts for today... most of which have been sarcastic and/or ornery... Good Luck! It really will be fine... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 6, 2009 Moderator Share Posted November 6, 2009 ;) North East Washington State, about 30 miles from the Canadian border. Incredibly beautiful country. Our facility is actually very nice for an extremely rural ER. We have lab and radiology departments, including a 16 slice CT scanner. No access to FAST in ER though. DPL anyone? I have never intubated a real person nor used a difibrillator... you will do fine. regarding dpl: the atls recommendation is to NOT to do dpl unless you have a surgeon there ready to do something about it. anyone with significant trauma needs c-spine precautions, 2 IV's/IO's, o2, portable c-spine/cxr/pelvis xrays, stabilization and immediate transfer to a place with a surgeon, preferably a level 1 or 2 trauma ctr. a positive dpl doesn't help you unless you can do something about it so don't waste the time. I work 1 weekend/mo at a rural facility and we fly all of our traumas out asap if they look like they need more resources then we have available. remember anyone with a pneumo gets a chest tube before they go on the helicopter because pneumos get bigger/worse with altitude. if the ems report sounds bad call the medevac service before the pt even arrives at your facility to check their availability and put them on standby( or activate them if you know it's bad; for example mva with 2 victims ejected through the windshield, hypotensive on scene). that gets their team on the pad on their end warming up the bird(or in the air) and if it is as bad as the ems report says they can be in the air within a min or 2 of arrival at your facility. you can always cancel them if it turns out to be nothing. at my rural gig we have activated 2 different medevac services for a bad motorcycle accident at the same time just based on ems hx and had both pts out within 30 min of the initial ems call, both with stabilization done and chest tubes in place. medevac #1 was on the pad with #2 hovering nearby waiting their turn. I should have gotten a pix. regarding intubation/airway issues. take the difficult airway course (ems version 350 dollars) asap. see www.theairwaysite.com remember to "vomit" in a bad situation: Vitals O2 Monitor IV Transport Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 6, 2009 Moderator Share Posted November 6, 2009 FYI CT, computed tomography; FAST, focused assessment with sonography for trauma; DPL, diagnostic peritoneal lavage; RTS, revised trauma score; ISS, injury severity score Link to comment Share on other sites More sharing options...
browndog Posted November 7, 2009 Share Posted November 7, 2009 Try to discover who the best nurses are in the ED.....and lean on them. They can save your butt. Link to comment Share on other sites More sharing options...
Devildog Posted November 7, 2009 Share Posted November 7, 2009 I recently took the FCCS (Funamentals of Critical Care Support Course) and I would highly recommend it to anyone who works with "sick" folks.. The course is full of valuable nuggets on stabilizing the unstable patient. http://sccmwww.sccm.org/education/fccs_courses/index.asp By the way, Good Luck... Keep us posted:) Link to comment Share on other sites More sharing options...
the cableguy Posted November 7, 2009 Author Share Posted November 7, 2009 regarding intubation/airway issues. take the difficult airway course (ems version 350 dollars) asap. see www.theairwaysite.com The difficult airway course is coming to my region in Spring and I plan to attend. Yesterday and last night went well. I had two MVAs (including a triple roll-over), chubby sausage digit vs. table saw, superficial partial thickness hand burn, and a sports-related concussion. Things quieted down by early evening and I actually got to sleep through the night without being called in. I even went to the gym this morning without being interrupted. The ER gods have smiled upon me. I hope I continue to find favor with them... Thanks for the encouragement everyone. Link to comment Share on other sites More sharing options...
MrSinn Posted November 8, 2009 Share Posted November 8, 2009 Try to discover who the best nurses are in the ED.....and lean on them. They can save your butt. I second this!! :) Link to comment Share on other sites More sharing options...
dreamin2baPA Posted November 10, 2009 Share Posted November 10, 2009 I can tell you from personal experience with the Difficult Airway Course, TAKE IT! If you are a rural ED PA never having intubated a live human, DO IT. After 23-yrs of advanced airway mgmt as a medic, I still learned a tremendous amount. Take the course. EMS part is cheaper and only leaves out techniques you would likely not be credentialed to perform. Link to comment Share on other sites More sharing options...
DizzyJ Posted November 12, 2009 Share Posted November 12, 2009 I feel your panic....A couple months ago I started a locums gig with ER solo coverage, but with no on island back up. I've already had a few medevac encounters. The nurses are pros and valued resources for helping me with stabilization and transport. You'll be surprised on how much you can handle when you are thrown into certain situations. Link to comment Share on other sites More sharing options...
goldenbodhi Posted November 13, 2009 Share Posted November 13, 2009 I have been trying very hard to find a gig like this but cannot move away from Denver area. I envy you. Always remember the FIRST thing you do in a stressful situation is Breathing. That is YOU take a deep breath. Then ABCDE. Link to comment Share on other sites More sharing options...
the cableguy Posted November 17, 2009 Author Share Posted November 17, 2009 Well my first weekend of call did NOT remain uneventful. Sunday went straight down the crapper. I guess I angered the ER gods by having the audacity to sleep-in till 9am while being on call... They smited me (whats the past-tense of smite? Smited or smoted? Heh, its 1am and I'm on call again. A little slack plz?). Anyways, things kicked off around 11am and went for 18 hours straight. We had to call in several extra nurses and administrative personnel to assist because our little ER totally got slammed. My first pt was a "routine" medical clearance in order to be shipped to a psych unit. Well, the guy turned out to be agitated and combative not because he was off his psych meds but because he wasn't sat'ing due to a big, fat multi-lobe bilat pneumonia. Fortunately, I had already called in my doc to assist with another complex pt that had arrived shortly after the first, so... we were standing together next to the 330lb pneumonia pt discussing what to do with him when his sats dropped down in the 20's (!). Talk about pallor and ashen complexion. Wow. It was something to watch. My doc nailed the intubation on the second attempt. During our full blown code we shocked him three times and successfully resuscitated him. Intense. We shipped him. Then we get the call for the two person MVA with extraction equipment being dispatched. Both passengers pinned under the vehicle. We shipped one. The other I spent three hours sewing his face back together. He was nice and comfy loaded up with vitamin "D", sleeping away while I worked on him. I will never forget his stale, smokey, etoh-laden breath blowing in my face. I had to step away several times to avoid wretching. I can look at anything but, man, smells just get to me. That night we also had a 32 wk gestation "contracting," and a severe asthma exacerbation that needed to be admitted. Plus the couple of pts that left because they realized it would be two days before we even got to them. Everyone survived and we got through the night. I finally finished around 5am. I was officially off the "clock" at 8am and thought "there is no way anything else could come in tonight." I thought I would go home and surprise my wife by climbing into bed with her since I had been sleeping in the call room all weekend. Got home. Quick shower. I was literally fluffing my pillow when the phone rings. Some guy in the ER with "cold-like" sx's. To be honest, I was a little irritated. Back in the car. I get to the ER and felt much better. This guy was pretty sick with a large abscessed abdomen. This guy actually needed me. Any irritation I felt quickly melted away. Mentally exhausting. I felt like a had played chess for 18 hours straight when I finally collapsed into bed. I LOVE this job but I'm glad my doc was on scene when "Mr. 330lb-tree-trunk-for-a-neck" went south. Good times. EM rocks. Good night. Link to comment Share on other sites More sharing options...
Devildog Posted November 17, 2009 Share Posted November 17, 2009 YEAH! BABY! YEAH!--Austin Powers Link to comment Share on other sites More sharing options...
orthotech Posted November 18, 2009 Share Posted November 18, 2009 CG- Is this your first gig out of PA school? If so, was it hard to find an ER position without any prior experience? I'm starting school in March, and I've always loved the ER. I'm certainly keeping my options open until after school but I've noticed most job postings for ER require experience. Just curious. And nice work with your solo call. I'm sure it won't be long until your kickin' *** and takin' names:D Link to comment Share on other sites More sharing options...
kirkc18 Posted November 18, 2009 Share Posted November 18, 2009 E I believe it is "had been smitten" Link to comment Share on other sites More sharing options...
CAdamsPAC Posted November 18, 2009 Share Posted November 18, 2009 Young Skywalker, come join me on the Darkside out in the Aleutians! If the medevac can get to you it's 2-3 hours away, the Coast Guard helo is at least 30 minutes out without a medic onboard, your MD backup is on the phone 700 miles away, and the Health Aide is out of town. Learn all you can do as best you can! You will be suprised how much comes back in a crisis. Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 18, 2009 Moderator Share Posted November 18, 2009 Young Skywalker, come join me on the Darkside out in the Aleutians! If the medevac can get to you it's 2-3 hours away, the Coast Guard helo is at least 30 minutes out without a medic onboard, your MD backup is on the phone 700 miles away, and the Health Aide is out of town. Learn all you can do as best you can! You will be suprised how much comes back in a crisis. so how do I get a gig like this??? getting some ER Experience now - hoping for 2 years then to a remote area Link to comment Share on other sites More sharing options...
kargiver Posted November 18, 2009 Share Posted November 18, 2009 Come to southern Vermont... Not quite as remote as the Alutians (I can be in Boston or Burlington in under two hours and I have plenty of shopping within 20 minutes of my front door) but I practice autonomously across the spectrum of EM. You name it, it comes though the door... and its all mine :D:D:D G Link to comment Share on other sites More sharing options...
CAdamsPAC Posted November 18, 2009 Share Posted November 18, 2009 so how do I get a gig like this??? getting some ER Experience now - hoping for 2 years then to a remote area Many of the Alaska Native Corporations operate health clinics across the state and Alaska requires the operators of remote industrial sites to have medical staff onsite. A lot of what goes on up here is PA networking about jobs. Link to comment Share on other sites More sharing options...
the cableguy Posted November 19, 2009 Author Share Posted November 19, 2009 Come to southern Vermont... Not quite as remote as the Alutians (I can be in Boston or Burlington in under two hours and I have plenty of shopping within 20 minutes of my front door) but I practice autonomously across the spectrum of EM. You name it, it comes though the door... and its all mine :D:D:D G Agree. We looked long and hard at taking a job in Alaska but we wanted something permanent (wasn't sure how we'd tolerate the day/night phenomenon that occurs there). Where I'm at in Washington state is very rugged and very beautiful. Yet, Spokane is just a two hour drive away and Seattle 6 hrs. Its also easier for fam/friends to come visit us here since we're not too remote. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted November 19, 2009 Share Posted November 19, 2009 Agree. We looked long and hard at taking a job in Alaska but we wanted something permanent (wasn't sure how we'd tolerate the day/night phenomenon that occurs there). Where I'm at in Washington state is very rugged and very beautiful. Yet, Spokane is just a two hour drive away and Seattle 6 hrs. Its also easier for fam/friends to come visit us here since we're not too remote. That element is overstated by those who haven't been up here. You can take a contract job for 1-6 months up in Alaska to actually experience what like up here is like. Some position will fly your spouse up for a site visit during the interview process. Don't let others tell you what you will like , see for yourself. There are many flights every day from Seattle to Anchorage and many connecting flights from there to the interior .There are many good rea$on$ to come to Ala$ka! Link to comment Share on other sites More sharing options...
goldenbodhi Posted December 6, 2009 Share Posted December 6, 2009 Cable Guy, are you in Brewster? I'm potentially interviewing there. Let me know. Link to comment Share on other sites More sharing options...
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