Moderator EMEDPA Posted August 28, 2012 Moderator Share Posted August 28, 2012 small rural e.d. double coverage with 1 doc and me. staff is 4 rn's and a tech. in house xray/ct/rt. intensivist 20 min away. 15 min to shift change and no pts so 2 of the 4 nurses already gone. doc tells me to take off as well. as I am walking out, elderly guy pushing elderly woman in wheelchair collapses in lobby. not breathing, no pulse. cpr started, put on gurney and brought to critical room. lots of ribs crunching with cpr. on monitor. vfib, defib x 1. no iv access, IO in. doc managing difficult airway with glidescope while I run the monitor and order meds. epi #1 in. cpr ongoing. now vtach. defib again to non-perfusing agonal rhythm in the 30's. back to vt. lido in. intubation done. defib again, back into agonal rhythm. oncoming nurse sticks head into room and says I need one of you now for another critical pt. I go. elderly lady between 70 and a million years old in severe resp distress, tripoding, can't speak. VS: RR > 50, bp 100/60, P 144, ST on monitor with deep st depressions, sao2 34%, yes 34%. on o2 at 100% by nrb mask. I tell a nurse to grab RT for bipap and to call the intesnsivist. no iv access and no ej's. IO in and 10 cc blood drawn for labs. pcxr ordered. I do an abg. lungs sound wet and doesn't feel warm. I ask for family from the waiting room for hx. the family is the guy we are coding across the hall. great. bipap on, sats improving. another nurse sticks in her head. I've got a chest pain. here's his ekg. stemi. of course it is. start the tpa checklist and call lifeflight(we have no cath lab). duck into the code. guy now has pulses and a bp. 12 lead ekg shows another stemi. no tpa for you with multiple rib fxs and 15 min of cpr. lifeflight #2. intensivist arrives for my pt and puts in central line on way to ICU. pcxr shows massive chf. order a bit of esmolol, ntg, and lasix as she leaves the dept. now talking in 3-4 word sentances. 24 hrs later all 3 have survived. both the code and the stemi were stented successfully. the lady with chf looking good and talking to her husband by phone(yes, he is now extubated and talking). this is why I love RURAL em. next day the docs wife makes me italian stuffed shells and cookies for staying late to help out after my shift was over. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted August 28, 2012 Moderator Share Posted August 28, 2012 Just another day at the office! Good Lord, dude. But you're right- quite the thrill ride to end the day. Excellent to hear all is well Link to comment Share on other sites More sharing options...
ajnelson Posted August 28, 2012 Share Posted August 28, 2012 That is why I loathe when the nurses get sent home early! Always turns into an end of shift disaster! Link to comment Share on other sites More sharing options...
chiaroscuro27 Posted August 28, 2012 Share Posted August 28, 2012 Amazing shift. Terrifying, but amazing! Link to comment Share on other sites More sharing options...
Just Steve Posted August 28, 2012 Share Posted August 28, 2012 Where was this bundle of fun? Out toward the coast? Great job Link to comment Share on other sites More sharing options...
Guest Paula Posted August 28, 2012 Share Posted August 28, 2012 And you are just the assistant! HAHAHAHAHA. Job well done. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 29, 2012 Author Moderator Share Posted August 29, 2012 Where was this bundle of fun? Out toward the coast? Great job yup, coastal resort town with large retired population. will tell you about it over beer( or did we decide on scotch?) next week with S.H. might be able to swing you a per diem position there if you want one after graduation. great group of docs and broad scope of practice. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 29, 2012 Author Moderator Share Posted August 29, 2012 And you are just the assistant! HAHAHAHAHA. Job well done. yup. after this cluster the doc said "great job, what are we paying you?". I told him and he said "that's not enough, let me work on that for you....." ( I appreciate it but I work there for the quality of the job, not the pay, which is 15/hr less than I make at my regular job). Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 29, 2012 Moderator Share Posted August 29, 2012 Ugh, Wow and a whole bunch of other words not fit for print.... that is why I left EM - I didn't get any training and felt that I would not be able to run something like that and that in itself was enough to scare the **** out of me..... GREAT job!!!!! How long did it take you to fall asleep after that night....... ride that night to a big old fat pay raise - think about it - you functioned as another attending and deserve some compensation - maybe that all ellusive job of pay and scope of practice is right there for you! Link to comment Share on other sites More sharing options...
marvi1kd Posted August 29, 2012 Share Posted August 29, 2012 That is epic! Well done EMEDPA!!! :) Link to comment Share on other sites More sharing options...
firefowl Posted August 29, 2012 Share Posted August 29, 2012 medic to medic..... gotta love it!! Link to comment Share on other sites More sharing options...
LIPPER Posted August 29, 2012 Share Posted August 29, 2012 Well played sir. Link to comment Share on other sites More sharing options...
Contrarian Posted August 29, 2012 Share Posted August 29, 2012 "10-ring"... Great Job and a splendid performance. Link to comment Share on other sites More sharing options...
Just Steve Posted August 29, 2012 Share Posted August 29, 2012 yup, coastal resort town with large retired population. will tell you about it over beer( or did we decide on scotch?) next week with S.H.might be able to swing you a per diem position there if you want one after graduation. great group of docs and broad scope of practice. Scotch, beer, tequila, bourbon, cigar.. the place that SH is talking about has it all available. Looking forward to the meet...and the discussion of per diem work :-) But first I need clinical placements :-( One step at a time. See you in a week or so. Link to comment Share on other sites More sharing options...
mjl1717 Posted August 29, 2012 Share Posted August 29, 2012 Wow! I don't know if Osler himself could have done better!! Very enlightening and academic.. Link to comment Share on other sites More sharing options...
PAstudentCanada Posted August 29, 2012 Share Posted August 29, 2012 I realize this will make me sound insane but that's my idea of a good shift. small rural e.d.double coverage with 1 doc and me. staff is 4 rn's and a tech. in house xray/ct/rt. intensivist 20 min away. 15 min to shift change and no pts so 2 of the 4 nurses already gone. doc tells me to take off as well. as I am walking out, elderly guy pushing elderly woman in wheelchair collapses in lobby. not breathing, no pulse. cpr started, put on gurney and brought to critical room. lots of ribs crunching with cpr. on monitor. vfib, defib x 1. no iv access, IO in. doc managing difficult airway with glidescope while I run the monitor and order meds. epi #1 in. cpr ongoing. now vtach. defib again to non-perfusing agonal rhythm in the 30's. back to vt. lido in. intubation done. defib again, back into agonal rhythm. oncoming nurse sticks head into room and says I need one of you now for another critical pt. I go. elderly lady between 70 and a million years old in severe resp distress, tripoding, can't speak. VS: RR > 50, bp 100/60, P 144, ST on monitor with deep st depressions, sao2 34%, yes 34%. on o2 at 100% by nrb mask. I tell a nurse to grab RT for bipap and to call the intesnsivist. no iv access and no ej's. IO in and 10 cc blood drawn for labs. pcxr ordered. I do an abg. lungs sound wet and doesn't feel warm. I ask for family from the waiting room for hx. the family is the guy we are coding across the hall. great. bipap on, sats improving. another nurse sticks in her head. I've got a chest pain. here's his ekg. stemi. of course it is. start the tpa checklist and call lifeflight(we have no cath lab). duck into the code. guy now has pulses and a bp. 12 lead ekg shows another stemi. no tpa for you with multiple rib fxs and 15 min of cpr. lifeflight #2. intensivist arrives for my pt and puts in central line on way to ICU. pcxr shows massive chf. order a bit of esmolol, ntg, and lasix as she leaves the dept. now talking in 3-4 word sentances. 24 hrs later all 3 have survived. both the code and the stemi were stented successfully. the lady with chf looking good and talking to her husband by phone(yes, he is now extubated and talking). this is why I love RURAL em. next day the docs wife makes me italian stuffed shells and cookies for staying late to help out after my shift was over. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 29, 2012 Author Moderator Share Posted August 29, 2012 ride that night to a big old fat pay raise - think about it - you functioned as another attending and deserve some compensation - maybe that all ellusive job of pay and scope of practice is right there or you! maybe in a few yrs....I think a full time job there is probably mine for the asking but the local schools suck and I still have school age kids....when they go to college though my wife and I are talking about moving there.... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 29, 2012 Author Moderator Share Posted August 29, 2012 I realize this will make me sound insane but that's my idea of a good shift. yup, mine too. have had a couple cool traumas there as well. 3 critical pts from 1 accident with just the two of us. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 29, 2012 Author Moderator Share Posted August 29, 2012 another thread from a while ago about the same place: http://www.physicianassistantforum.com/forums/showthread.php/31559-Why-I-love-rural-EM?highlight=rural Link to comment Share on other sites More sharing options...
Hemegroup Posted August 29, 2012 Share Posted August 29, 2012 I would have to sing. Whenever I have to switch to 'manic' mode, I find that singing or humming a quick phrase between commmunications helps keep me grounded. People think I'm insane but whatever. So my question to you is did you sing a song or if you would've, which one would it have been? My last was 'painting the roses red' from Alice in wonderland. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 29, 2012 Author Moderator Share Posted August 29, 2012 didn't sing a song but if I did it would have been bon jovi "have a nice day" ("when the world gets in my face I say, have a nice day....") or van halens "right now". Link to comment Share on other sites More sharing options...
rcdavis Posted August 29, 2012 Share Posted August 29, 2012 Nice job e Link to comment Share on other sites More sharing options...
ToppDog Posted August 29, 2012 Share Posted August 29, 2012 awesome story! I kinda agree about the nurses leaving early thing though. Maybe the doc will rethink that now. Link to comment Share on other sites More sharing options...
medic25 Posted August 29, 2012 Share Posted August 29, 2012 Nice job E; sounds like a fun shift! Unfortunately you won't get an ounce of credit with any of them on Press-Gainey, but the earache since 2009 who had to sit in the waiting room while you coded them will get a survey and complain about the long wait to be seen! Link to comment Share on other sites More sharing options...
PAstudentCanada Posted August 29, 2012 Share Posted August 29, 2012 yup, coastal resort town with large retired population. will tell you about it over beer( or did we decide on scotch?) next week with S.H.might be able to swing you a per diem position there if you want one after graduation. great group of docs and broad scope of practice. Dammit! I am jealous of that. I wish I was American (for more reasons than just this!). Link to comment Share on other sites More sharing options...
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