Last day!

Day 2 Cadaver Lab

Who would have thought that I'd be kind of excited at doing a cadaver lab? Well, I guess most of my PA friends would think this...and therefore, know that, yup, this was exciting.

One of the worst parts about learning about medicine is that we often do things on patients for the first time. They might not know this, but I'd expect that they usually experience more pain because of someone doing something for the first time on them. I have been on the receiving end of a "first time" and I can tell you this much. No fun. Not one bit.


So, if someone says..."hey, try this Chest tube, this IJ, this SC, this intubation, this retro-intubation, this IO access, this cut-down, this femoral cut down, this femoral access, this thoracostomy this decompression, this cricothyrotomy" and it's not going to hurt any patient? I am ALL about it.


We are all listening carefully!

 There were 3 bodies which meant 5 to a body. Quite generous. I learned that there are 2 sorts of bodies- fixed and unfixed. We were working on unfixed bodies. This means a lot of great things like organs are pretty much exactly as you'd expect, and there is no real "rigor" that has set in.

                                            

And we did every one of those things above mentioned things today. Packed a few noses, did a few digital blocks, a few arthrocentesis and thoracentesis. They then did a demo of cracking a chest, and we were able to feel the aorta, as well as the heart and other organs. While this is not done often anymore (nope, not Greys Anatomy in real life!) it remains something that might be done as a "you have no other choice" thing.

Okay, so certain things are tough to do when there is no blood flow, but it is, after all, about proper technique and they made sure we were doing it right.

I know it's not 'tea life' but it's a lot closer than I have gotten. This learning is FUN. A lot of fun.

Afterwards, we had a dinner in the conference room, the stinky, smelly bunch of us.

The food here has been great! They correctly assumed that we would not like an "out" dinner but would prefer an take out kind of dinner. Perfect!

Doesn't Jamie look GREAT in this yellow hat?

I then went to everyones favorite store with a new found friend and got yet even more poison ivy stuff.

Day 2 AM

This AM was our Ultrasound workshop.  Truly a terrific experience. I had done a sort of FAST exam at school, I now know I was doing most of it wrong. And honestly, did I even actually SEE anything when I did them before? Eh, probably not.

Clearly not. (Is US ever really clear???) No, I think not. But now I have a few more things I can add.

There were pearls galore. Again, while I think I learned a lot, I won't actually know until I hear it some place later and can pull it into my brain to utilize in practice.

So, our US lecture was...amazing, What a great learning experience it was.

Yes, I am over my head. I just graduated...but what I do know is when someone can teach. These people can really teach and enjoy teaching. Patient? Kind? all in huge measure.

So a few pearls....again, I am positive I am not getting all of them in, but that's just how it is. The immense amount of information is just that.

• US is pattern recognition and therefore, practice makes perfect.
• US answers specific questions
• Hi freq=Higher resolution
• Lo freq = increased tissue penetration
• Buttons? Don't let 'em scare you. In the ED you don't need most of them
• Make sure you have the right probe and the right setting
• Look for your indicator- your probe should be in line with that. Usually, indicator towards head, or pt right side. Only exception is when you're doing an IJ (or at the head of the bed)
• BART for flow. Don't assume that blue is venus ever.
• Full bladder? Acoustic window. Sound transmits better.
• Shadow artifact? Can be helpful  or "really make you angry!"
• Stones have an initial shadow maybe, but when you fan or move the probe, there is no longer a shadow
• "Getting good images is the first step for getting good info!"
• FAST Exam answers 4 questions
• pneumothorax
• hematoperineum
• hemothorax
• pericardial effusion
• Most important question answered is "WHY IS MY PATIENT IN SHOCK?"
• Anything other than an extended FAST is an incomplete FAST
• FAST is part of the primary survey. It is nothing more, and nothing less. 

This is our first station this AM- US guide for CL placement. Terrible picture of a great station. Now I want to use US for everything.

This is also a horrid picture, but what used to just be grey lines is now beginning to make some semblance of sense to me. Maybe...

A few minutes after lunch, one of us decided the sun was just too warm and nice to not take advantage!

Truly, our fearless leader, doing the mandatory safety lecture before cadaver lab.

Before cadaver lab. Everyone still looks fresh, and still smells GREAT!

Day 2

This am was different ultrasound techniques and pearls. We again were divided into groups of 3, and rotated thru 5 stations.

Again, I feel I got a great natural progression, starting with vascular access and then seeing gallbladder, aorta, renal, and finishing trans-vaginal.

I never thought that I'd be fascinated by ultrasound... Always thought it was a bunch of grey lines. But- truly impressive when you get a glimmer of understanding.

More later! Off to cadaver lab!

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Day 1

Wow....

This afternoon was started with suturing. My last sutures were put in-oh- months ago. Like EKGs, this (clearly) is something that demands practice on a daily basis.

Thankfully, that should not be an issue in the coming months. Today? Felt as if I had never sutured anything in my life. I admit feeling quite stupid. Two thumbs anyone-on one hand!

Lots of learning, pearls. More of those later.  I wish I had a notebook with me! I have so many things I wish I had written down!  I admit being tired, and so I am sure I have forgotten a ton.

Some pearls:

• Allergies to lidocaine? Can infiltrate with benadryl
• Careful of scalp wounds and excessive amounts of lido- can lead to "too much lido" because tissue is so vascularized. 
• DOCUMENT sensory exam before blocking fingers/digits
• Water is excellent for irrigation
• numb before cleaning
• Minimize debridment

Have to say it again, this is a totally non-pressured, enjoyable experience. 

The age ranges are extreme, really. Its about 5 PA's, 5 NPs and 5 MD's. One is as from far away as FL. Several from MI (Their practice paid for them to do the 2 year certificate as well as attending this workshop. Quite great bene's I must say!). Most are already in an ED practice, but there is one other brand newbie like myself here. 

I am thankful!

Tonight, dinner at a Japanese steal house. My favorite!

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Today's suturing session

This is Maria, and this is actually a pig trachea, used for doing cric's
 Not like this will transfer directly to my practice, I assure all my future patients!

Pigs feet before...

The gentleman on the right was John, in his last year of ED residency, who patiently guided me thru several different kinds of sutures.  Very very appreciated!

Pigs feet after.

Lunch videos

This afternoon, this played on the screen while we ate lunch.

Pretty cool...

Pretty funny!

http://health.discovery.com/tv/bizarre-er/

Morning session

We jumped right in this AM and had several groups breakouts.

I felt lucky and ended up with what seemed to be a logical progression- beginning airways, more complex airways, LPs, cardiac (think ACLS without pressure), vascular access( femoral, sub-clavian, supra-clavian, IJ, as well as radial). We then worked with doing several different cricothyrotomy techniques on pig tracheas.

Oh my! Everyone was so patient- and being a WSU student, loved having actual working sim dummies;)

Thus far, instruction is TOP notch- my head is exploding with information.

Pics to follow....

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Breakfast

We have arrived! Breakfast (for me, my 2nd!) is served, and we are all busy looking over our info packets.

All ages- 20's- late 50's I'd say, all different backgrounds are here. I'll get permission and hopefully post some pics soon.



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Good Morning from Morgantown WVA

Well, I as usual could not sleep- this is more normal for me than not.
Perhaps today will bring enough tired to sleep comes easier.

The room is great- bed really comfy, and I had a great shower. Getting dressed in scrubs for a morning in the sim lab, and casts and splints this afternoon.  Hopefully I can update from the campus, with lots of pictures for everyone.

West VA Procedures Workshop

This first set of posts marks several things:

• I am official-Licensed, certified in NC.
• I start work soon!
• I am embarking on the West VA Emergency Medicine Procedures workshop

I chose to do the procedures workshop as a gift to myself- my very own graduation gift! 

I had heard about the program both thru SEMPA, as well as my SP at Mission mentioning it to me during my interview.  

I have just gotten to Morgantown, and have met a few of the other group members, and am settling into my nice, cool hotel room at the Hilton (with a great rate!) after my a yuengling and wings at BWW next door. I am quite excited, and despite a rather long week leading up to this day, it feels GREAT to be here!

I am in room 324- for those that know me, I am all about numbers and their ties, and my first child, Jasmin was born on 324. So somehow, significant that this room is my room as I start on this journey.

The drive was beautiful. The roads were twisty and windy. I think I twisted and winded a bit more than most, but that's okay- my beloved iPhone developed a crack at the home button, which cause all sorts of odd things to happen, which included it to become hot as hell, and lose the screen several times. This made the GPS program (which at best sucks) even worse, and the car I am driving, while having an actual GPS in it, probably was last updated before there were more than 48 states. I am only kind of kidding. 

So hopefully I will update this during the event- it's a crazy busy schedule, but I am very excited! 

(Can you tell??)