27 September 2010
Honestly, I had no clue what was going on. I arrived at 7 am (thanks to my roommate showing me where to go, because I had no clue where the "crossroads" on floor 2 of Parkland Hospital was.
The Med Student and I stood around waiting for our Intern to come pick us up and show us where to go. We waited more than half an hour, but the he finally came. We went to see a patient. Then to clinic.
Clinic was mostly follow up patients who had some kind of vascular surgery before. But we had a really confusing Electronic Medical Records (EMR) system that my head was spinning trying to figure out. How do you see a vascular patient? Is it the same? Which of the 5 vascular surgery students (my teammate and I were working with the vascular surgery students from St. Paul Hospital) gets to see the first one? What is going on?!
The med student went to see a patient, and we only had one, so I went with her. Because I wasn't sure what to do with the EMR system. And I wasn't sure I knew what to do. But after watching her, I felt much better (and more confident: I CAN do this, I have been doing this, and we don't really need to use the EMR to see the patient.) Sweet.
Then we rounded with the St. Paul students and our Attending, so there were 8 of us walking around (attending, resident, intern (an intern is a 1st year resident), and the 5 medical stundents) Then we all had lunch with our attending and learned about Acute Vascular Insufficiency.
Some random facts about Acute Vascular Insufficiency (I was the only one who didn't take notes, so I wanted to write it down before I forgot, to help me learn it. Really, you don't have to read this): When a vessel (artery or vein) gets occluded from a thrombus. Clinical Presentation is 6 Ps: Pulselessness, Paresthesia, Poikilothermic (cold), Pale, Paralysis, Painful. Things to order: CBC, CMP, EKG, etc. Also ask a good history to help you find out what the cause of the thrombus was. There are a few different categories. I know 1, 2A, and 2B are the ones you consider therapy for. (3 is basically a dead limb, so you have to amputate.) You give everyone Heparin as a 80-100 mEq/kg loading dose and then 18 mEq/kg per hour. Then you consider tPA, which would break up the thrombus. There are a few contraindications to tPA: disease > 14 days, bleeding (trauma, recent surgery, stroke), etc.
After lunch, we learned a few more things, and went to research our case for tomorrow. Our 3rd year Resident made us look for an article on Fenestrated EVAR (which is a fancy kind of aneurysm repair, it's pretty new). Only, we spent about 45 minutes looking for it on OVID, PubMed, and even Google before we gave up and emailed him. We read a few other articles along the way (which is why he made us research it…)
So, tomorrow I'm looking forward to scrubbing in on an 8ish hour surgery! I'll let you know how it goes "scrubbing in!" (and how it goes getting to the hospital before the world wakes up: 4:30 am...I might as well sleep there!)