Weeks 56, 57, & 58: So Close, Yet So Far

It’s just about that time – the course material is piling on and finals are just around the corner. I feel a bit differently though, not so much stressed, but rather anxious. Yes, with every day that passes I inch closer and closer to exams week (last final exam week ever!), but also to encountering my first real patients out in the field. I’ve never felt any more ready for this change…so close, yet there’s still so much to get through before then.

As you can imagine, we have covered a ton of topics over the past few weeks (haven’t had a solid hour of freedom, even to write a blog, until now!). In Clinical Skills, we learned how to perform a FAST (focused assessment with sonography for trauma) exam on each other, which is an ultrasound assessment used in the emergency setting to assess for blood or fluid collection in the chest (around the heart), abdomen, and pelvis. The procedure takes no more than 5 minutes to complete, but it’s such an important and life-saving exam to master. We also learned how to use ultrasound to assess vessels of the neck (carotid and jugular) and the thyroid gland, in addition to aid in the insertion of IVs into vessels. It’s much easier to insert an IV into a vessel using ultrasound, as you can actually watch (on the ultrasound screen) the needle/catheter as it approaches and enters the vessel that you are targeting. We also learned how to insert nasogastric (NG) tubes into patients. A nasogastric tube is inserted through a nostril of the patient and advanced through the nose, down into the mouth, through the esophagus, and into the stomach (or even as far as the intestines), for purposes such as feeding. Lastly, this week, we learned how to acquire EKG readings on one another. It’s one thing to have interpreted hundreds of EKGs up to this point, but actually knowing how and where to place the electrodes on the patient to acquire the lab test is pretty important too! I really appreciate this class in that it’s a great break from reading textbooks, articles, and lectures, and focuses more on the hands-on skills that we’ll be performing on patients in about five weeks from now.

Besides the hands-on skills learned over the past few weeks, the books haven’t remained closed in all my other courses. In Emergency Medicine, we’ve learned how to manage a wide variety of drug toxicities/overdoses/withdrawal symptoms that patients may present with to the ED. Many drugs have a single antidote (treatment that stops the action of the toxic drug), but the treatment for other toxicities are fairly complex. This week, we focused on the treatment of trauma patients, specifically those who present with trauma to the head, spine, chest, abdomen, and skin (burn victims). Time is definitely not on our side when treating patients with these traumatic injuries, and I’m sure I will see plenty of cases such as these while out on my emergency rotation. In Family Practice, we learned how to work-up patients who present with abdominal pain, muscle/joint aches, and syncope (fainting episodes). We have also started to learn about the seemingly treacherous task of billing for services provided to patients. I’m honestly shocked by the intricacy of the process and also by how many hundreds of billing codes exist based on procedures performed, diagnoses made, questions asked, time spent with the patient…it’s incredible. In Pathology, we learned the processes of diseases affecting the urinary, reproductive, and endocrine systems, in addition to the skin. Finally, in Pediatrics, we’ve been focusing on the diagnosis and treatment of respiratory, cardiology, and gastrointestinal conditions in this younger age group. Again, most of these conditions are diagnosed and managed similarly in adulthood, so it’s an awesome review of past information (with enough new information to keep me busy).

Rotations truly became real last week after our clinical rotations orientation. We were loaded with information pertinent to the next year of our lives, and this was just as stressful as the orientation day leading up to my first week of PA school, about 1.5 years ago. The clinical year will entail much more than just showing up to our assigned site each day throughout the four or eight week cycles; there is also a lot of work and outside studying we’ll be doing in the spare time that we have. Our work weeks are, on average, 60-80 hours (some will be more like 7 am-5 pm work days, like in offices, others will require 24 hour on-call shifts, like surgery and OB/GYN), so I’m not quite sure where I’ll fit this “spare time” into my schedule, but that’s part of the fun of rotations I guess. I’ll give some more details about my clinical year later next month. First, I have a couple more weeks to push through…

Question of the week: What is the most common cause of syncope (fainting) in patients younger than eighteen years of age?

Last week’s answer: Your patient presents to the emergency department with a dislocated forearm bone. You should take an x-ray of your patient’s forearm before AND after the splinting process.

Clinical Phase Countdown: 38 days, 1 hour, 22 minutes

Weeks 54 & 55: Change Is Coming

I cut a long piece of cloth, resembling the texture and shape of a sock. I asked my ‘patient’ (a classmate) to hold her arm still as I slid the cloth over her hand and halfway up her arm. I then wrapped several layers of a cotton-like material over the “sock” on my patient’s arm, and prepared for the application of her arm splint (similar to a cast, but not encircling the entire limb). I then stacked eight sheets of plaster, which resembled the same size and shape of a piece of printing paper, and dipped the stacked sheets of plaster into a bucket of warm water. Placing the dampened plaster over the right side of my patient’s right arm, I molded the plaster splint around her forearm and thumb (since I was treating her for a lower thumb fracture). After several minutes, the plaster began to solidify, and I applied a few final layers of coverage (elastic bandages). Just like that, I had splinted by first (imaginary) fracture!

As is apparent, this week in Clinical Skills we learned how to splint a variety of bone fractures. Applying a splint is actually much easier and quicker than I expected it to be, only taking about ten minutes. From finger, wrist, and forearm fractures, to ankle sprains and lower leg dislocations, we practiced a good amount of splinting on one another. I splinted one arm and one leg of my partner, and she did similar forms of splints on my limbs as well. Something tells me this process will be a bit more difficult to perform on patients with actual fractures…those who I can’t tell to lift their arm or to keep their hand straight throughout the procedure, as we were able to say to one another during these practice runs.

The past two weeks have been gratefully manageable. In Emergency Medicine, we have been focusing on treatment of patients who present to the ED with endocrine emergencies, like diabetic (high/low blood sugar levels), thyroid, and adrenal gland emergencies. In Family Practice, we reviewed/learned how to work-up patients who present with fatigue, urinary tract infections, tick-borne diseases (Lyme disease), sexually transmitted infections, and infections of the skin (MRSA and fungal infections). Pathology has shifted focus to the study of the causes, manifestations, and microscopic appearances of a variety of gastrointestinal tract diseases, including diseases of the liver, gallbladder, and pancreas. Finally, in Pediatrics, we have started focusing on the diagnosis and treatment of HEENT (head, eyes, ears, nose, and throat) conditions in children. Since many of these conditions manifest similarly in adulthood, the past couple of weeks have been a great review of what we have covered over the past three semesters.

This semester is flying by! Only five weeks of classes stand between me and the completion of this first phase of PA school, and I am getting so anxious for the change that’s about to come. The next couple of weeks will get a bit crazy, mainly because I’ll have two eight hour days to endure this coming weekend, for a Radiology (x-rays, CT scans) review course on Saturday, and my clinical year orientation on Sunday. It’s never a good thing to lose a whole weekend, especially when it’s the only time available to catch up with the previous week’s material…but, too little time left to start complaining now!

Question of the week: Your patient presents to the emergency department with a dislocated forearm bone. When should you take an x-ray of your patient’s forearm? Before splinting, halfway into the splinting process, or after splinting (more than one choice may apply).

Last week’s (midterm) answers: True; Motor vehicle accidents; Subcutaneously; False; Endocrinology

Clinical Phase Countdown: 57 days, 1 hour, 35 minutes