Wednesday, April 8, 2009

Great day

I had a great day today! But since it's 10:04 pm and I'm due back at the hospital at 5:30 am, I'll be brief by summarizing the events of the day:

(1) Slept well last night. Got up and rounded on my few pediatric patients with a positive outlook on the day.
(2) Attended rounds with the team. Helped put in a central venous catheter with one of the surgeons. She walked me through it so that if I ever had to do it on my own ....
(3) Went to the OR with one of the patients. Did the intubation, then scrubbed in for the case. The surgeons let me participate!
(4) Finally ate some breakfast - cinnamon raisin bagel with a mocha latte (=coffee with hot chocolate). Didn't get around to eating the remaining breakfast - hard boiled eggs and pear.
(5) Spent a considerable amount of time trying to figure out if my patient with the amputation has neuropathic (aka "phantom") pain. Once I determined that her pain likely is neuropathic, I spent a considerable amount of time learning how to treat it. Once I had gained that knowledge, I spent a considerable amount of time figuring out if we - given our limited pediatric pharmacy resources - even can treat it. Turns out that we can. Wrote the order.
(6) Saw a medic from my unit for chronic cough. The CO had sent her to me because she didn't feel that she was treated appropriately in the outpatient clinic. Looked at her XR and gave recommendations.
(7) Tried three time to put a feeding tube down the patient with the amputation. Had to have four people hold her down in the process. Two-year olds have mighty strength when they think that you're going to hurt them!
(8) Gathered various fruits for the patient since her tube feeds do not have enough daily fiber. Was able to locate and cut up green apples, pears, plums, dried cranberries, raisins, prunes, and dried blueberries. Served them all to the patient and implored her brother to help her eat some of it.
(9) Talked for about an hour to the PA who first treated with patient with the penetrating head injury. He was doing a routine humanitarian mission in the area when a local Afghan man brought the patient to him. He had a minimal medic bag, but was able to intubate and stabilize her before the flight medics arrived to bring the patient to the hospital. It was an amazing story and I very much enjoyed hearing it from the horse's mouth.
(10) Made some uber-ramen for dinner. I had to put it into three cups for microwaving because I couldn't find a bowl big enough!
(11) Called the pediatric neurosurgeon when one of the patient's ventricular drains began to leak (a ventricular drain is a pop-off mechanism so that some of the spinal fluid will drain off if the pressure in the head gets too high). Assisted in fixing the drain.
(12) Went back to the little girl with the amputation to find that she had eaten almost an entire pear, half an apple, and two prunes. Success!
(13) Checked the orders for all of the patients for morning labs. Don't want to miss anything or draw any labs that are unnecessary. Checked in with all of the nurses in the process (a habit I got into as a resident; I found that if I checked in with the nurses before going to bed, I could avoid getting paged overnight ....).
(14) Returned back to the barracks for a very quick combat shower and to hit the sack.

So that was my day! It was more busy than the average (mostly because I made it that way) but very rewarding and even fun!

2 comments:

  1. 2 year old with amputation :(

    Combat uber-ramen :)

    I didn't know the little girl lost her arm. Maybe I missed it, but I thought it was up in the air a couple of days ago. I guess that's enough time for it to change, but that's still sad she lost her arm :(

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  2. I must have forgotten to update everyone on her progress - sorry! The surgeons tried valiantly to save the arm, but ultimately they were unable to do so. She now has about half of her upper arm left, but there's no skin covering the muscle, fat, and bone (it's known as "degloved"), so she will return to the OR tomorrow for skin grafting.

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