Subaqua Sternal Rubs

This afternoon was the much anticipated first rotation (out of 5) in the Accident and Emergency Department. I was impressed with A&E starting with the waiting room, mostly because of the huge sign that said:

What I wouldn't have given to put up a sign like that in the ED where I work(ed), though I would make it 4AM instead.

Other than that, we didn't get to see much of the A&E (other than the fact that it had about 10 rooms, 2 resuscitation rooms, and an "asthma bay," where two kids were happily sucking on nebulizers), as we were whisked off to do guess what? Yup, another history and physical. Our patient was a 45yo male salesman who c/o lower abdominal pain which radiated to both flanks, accompanied with nausea and vomiting. Unfortunately, it was not anywhere near the critical care level the adrenaline junkie side of me hoped to see in A&E, but still a learning experience. Though the physical exam less so, as the pt had been drugged up with pain relievers, and the abdominal exam revealed absolutely nothing. As laboratory and imaging studies were not back yet, we didn't have a diagnosis more definitive than rule out kidney stones or rule out appendicitis.

After reviewing our history and the differential diagnoses with us, our precepting physician was signing our "green cards" (hospital rotation cards to prove we actually attended), the adrenaline junkie once again got the better of me, and I asked if it were possible to do an EMS rotation. His reply?

"Aren't you here to learn the history and physical? I don't think they do that on the ambulance."

Ok, so while some people who abuse the EMS system think it is a taxi service, it is in fact not. Seriously, does he think that EMS just throws the patient in the back of the rig and drives them to the hospital without saying a word in the 30 or so minutes it takes to get there? Most EMS providers do perform a history and physical to figure out what is wrong with the patient, so they can 1) give appropriate treatment and 2) give report to the hospital. Though to be fair, I don't know what level of training the EMS has in St. Vincent, and they may be just "ambulance drivers."

The precepting physician also added:

"Doctors do not go out on the ambulance, so you would have no supervision."

Of course he did not know that I have been a certified EMT/AEMT for the past 6 years, and haven't killed anyone yet. (Despite trying once or twice.) And to be honest with you, I really wouldn't trust some of the students here, or some of the students that rotated through the ED where I worked back home. Either 1) they know absolutely nothing, or 2) they'll rattle off every possible diagnosis out of Robbin's Pathology without ever mentioning the obvious one.

Oh well, maybe one of the other docs will let me play with the lights and sirens. (And save some lives, of course.)

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