Saturday, June 29, 2013

The anatomy of placing a traction pin in the Pediatric ED.

So every now and then there's adult patients that need to go to the pediatric ED for trauma triage and whatnot. They occasionally need traction pins placed...

The first step is informing the nurses that a traction pin needs to be placed...










To which the usual response is: 'You're going to sedate for that, right?'












This is usually followed with a general sense of nursing panic...












I try and start with...















And after an indeterminable amount of arguing...














I finally relent and agree to sedate the patient, which leads to...












And what normally takes 15 minutes and a vial of lidocaine in the ED has not become a hour long ordeal involving multiple health care teams, hundreds of unnecessary health care dollars spent.  Which is why when it comes to traction pins in the Peds ED...

Me: 'I just need you to sign right here.'
Pt: 'I can't move my hand.'
Me: 'You just moved your hand by gesturing that you couldn't move your hand.'
Pt: 'Nope.'



I had my last sign-out as a second year....it...did not...go...well....

I officially start my third year on suspension starting next week...  But then again, I haven't had a weekend off in over 3 months, so....
















(With any luck, death by snu-snu)

Friday, June 28, 2013

Wednesday, June 26, 2013

So I'm on call from 6PM to 6AM when I have to give sign out.  This week, sign out was voted to be moved to 730...


So I haven't operated in 3 months, and head to county next month where i'll be expected to run rooms by myself.  I expect this first week to go like this with the surgical tools...

Yeah, remember that gif of me walking in to the ED to reduce a shoulder?(http://orthopedicresidency.blogspot.com/2013/06/i-got-call-from-ed-about-shoulder.html)

I just had one I couldn't reduce and scheduled for an operative reduction...


Tuesday, June 25, 2013

So an ED nurse was putting a moist swab in the patients mouth and said 'Open your mouth.  I'm going to put something in, it's going to be wet, just suck on it a little bit'...


Last night an older intoxicated patient was hitting on a nurse by telling her that he had a large dong, and then proceeded to bare to her his rather large manjunk as proof...


After getting report from an outside hospital tonight that the patient had a 'type 4' supracondylar humerus fracture...




















(It was a type 1, flexion type).

Monday, June 24, 2013

Call from the peds surg resident: 'Hey, I know you guys are pretty much done with the patient, but would you mind transferring her out of the ICU to your service?'

Whenever a patient leaves the ED AMA...

Friday, June 21, 2013

My female attending this morning was talking to us about ex-fixes and said: 'size really makes all the difference in the world.'  The back of the room...


So an ED resident asked if I'd be on standby while they did a distal radius reduction.  I sat and watched....it went interestingly....

Without exception, this is my thoughts to my humerus post reduction films...

So every now and then my senior will tell me to do something which my attending disagrees with.  When the attending asks what my senior told me, this is the following conversation....


Thursday, June 20, 2013

As someone who tends to sweat during difficult reductions, this is usually the scene when the post films look awesome...



Wednesday, June 19, 2013

I just had a blasted distal radius fracture that was reduced to almost anatomic.  Looking at post reduction films...


Monday, June 17, 2013

So I went to get some cookies that a female med student was standing in front of. She kind of shuffled out of the way to let me through.
Me: 'You're fine'
Me: 'Wait, poorly worded, you're okay.'
Me: 'Wait, umm...crap.'
(back out of the room without cookies.



What it feels like to ask a question during indications which would get the attendings arguing for a while...



Sunday, June 16, 2013

Me: 'Hey, so about that hip dislocation consult, I don't see any films, am I missing something?'
ED resident: 'No, the consult was just based on the physical exam.'


Friday, June 14, 2013

How most of my arguments end with attendings...


(While applying a plaster cast)
Nurse: 'You're kind of getting plaster everywhere.'


My pseudo-humble response to an ED attending that complimented my anatomic reduction the other day...

So I grabbed a nearby attending, showed them a lower extremity fracture consult in a pre-teen that i was going to put in a splint so they'd get paid....the attending had me put on a spica instead...

I had an intern point out a patella fracture on an ipsilateral tib/fib right before sign out...




Wednesday, June 12, 2013

 I had a patient with a hand laceration that needed repair and I was at bedside.  Direct quote from the ED nurse to the patient: 'I know your pain isn't that high right now, but we should give you some pain meds to knock you out a bit. The doctors about to touch you...'


So I tried to contribute to an ED and trauma surgeon attendings discussion on a head CT.  It went like this...

Tuesday, June 11, 2013

So on night float, I leave my pandora station on.  Last night, macklemore's 'can't hold us' was on when i finished the last consult at 3AM and got back to the library.  The following ensued...


Anytime an ED resident says they saw my blog...

Monday, June 10, 2013

I got a call from the ED about a shoulder dislocation they couldn't reduce.  This is pretty much how I entered the ED...



Friday, June 7, 2013

Trauma team senior: 'You guys don't do anything about transverse process fractures right?'
Me: 'Nope'
Trauma senior: 'Sweet, we don't need a consult then.'


ED nurse: 'We were waiting on you to start sedation.  Were you taking a giant poo or something?'

I had a monteggia fracture yesterday.  Got it reduced great and casted.  Went to take one last look with the c-arm to make sure the radial head was still reduced before bivalving...

.
When the SICU pages the second time asking if I'm going to transfer out a patient...


Thursday, June 6, 2013

So there was a Schatzker 6 tibial plateau in the ED.  Me and the ED attending pulled on it...and ...somehow...made it worse...


My immediate thoughts while sitting with a patient waiting for the cast to set, after saying: 'Now we just sit here and wait for it to get hard'...

Wednesday, June 5, 2013

ED attending: 'So if you want, my scribe can write up your consult for you...'














Followed immediately by...




So an ED nurse wrote me up for taking a kid out of traction that was digging into his crotch....without....sedation...

Monday, June 3, 2013

I sometimes get hit on at work, pretty much exclusively by female patients over the age of 75.  Regardless, I still feel like this...



 Last night while I was interviewing a patient, the woman in the bed next to us had a round of (what sounded like forced) flatulence.  This is what I pictured...


I got scolded by a peds ED nurse for not consciously sedating a kid that needed his near amputated fingers only irrigated...