Friday, July 21, 2006

Today I got to leave work a few hours early to go to a patient simulator with the other students on my rotation. The simulator is actually pretty cool: it's a mannequin in whom pulses are palpable in the extremities, heart/breath sounds are audible when you press your stethoscope up against the chest, he can be intubated and the internal anatomy is very accurate to real life: you can end up intubating the esophagus down to the stomach instead of the lungs, or have the tube go down the right bronchus and only oxygenate the right lung.

It's also totally fun: they basically split us up into a couple of groups and then each group in turn takes care of the simulator, who is inevitably critically ill and ends up crashing. The simulator is controlled by someone operating a computer in another room, and this person is also hooked up to a microphone, and they respond to your questions as though they were the patient. A nurse stands in the room with you, and she administers "drugs", EKGs, etc. A few minutes after you a request something you are handed a sheet with the lab results, or imaging, or whatever, on it. You can place verbal orders with the nurse, which is tough because none of us know the dosages for sedatives and paralytics (which must be administered before intubating), or pain meds, etc, and we always end up wasting time flipping through our little medicine books.

The hilarious part is that while you're in there sweating and freaking out [they do a pretty good job of making it a pretty high pressure scenario], the whole thing is live fed to another room where the other med students sit and watch you, and laugh at the incredibly dumb things you say and do.

And I must say -- it's very easy to sit in the room and laugh when someone can't remember the difference between dopamine and dobutamine, but when you're in there with the mannequin trying to read the EKG with all the machines in there beeping and the nurse asking you what dose of epinephrine and whether you want it subcutaneously or IV and the fake patient demanding to know what the hell's going on, it's a little stressful. Like, I realize exactly how ignorant and ill-equipped I still am.

I am happy to say that my partner and I were correctly able to diagnose and treat our patient without sending him into cardiac arrest. Hooray for saving the mannequin! I actually had a really tough time keeping a straight face, because the doctor who was running the simulator was a total joker who kept saying things like "I think I just wet myself," and giving hints to the other groups like, "Doctor, do you think that maybe I need to be defibrillated?" Which reminds me of a nightmare I had a few nights ago where a patient crashed and for some horrible reason I (the least qualified person in the hospital) was running the code. [EVEN MY DREAMS ARE SQUARE.]

And also...I LOVE NURSES. They have so much practical experience and knowledge, and they're the ones that administer direct care to patients. Hospitals would be nothing without their nursing staff. They are also very friendly and will teach you medical-type things without making you feel like an idiot or pimping the hell out of you.

Today's Procedure of the Day: Somebody came today with a chief complaint of "wax in my ears." Dude, it takes ALOT of wax in one's ears to bring them to the ER. Her hearing was impaired, and when I looked in her ears her ear canals were totally occluded by wax. So I got to attach a catheter to a 30cc syringe and flush her ears out with saline! It was a little gross yet oddly very satisfying to see all the big chunks of wax come flooding out. (But then, I'm the sort of person who likes to look at the hairy wax strips after I get my eyebrows done.)

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