Last Friday night I spent 7pm-7am in the hospital Trauma Shadowing. I've only done it once before (first Trauma Shadowing post), but I wanted to see if Baltimore was any more dangerous or accident prone in August than it was back in March.
The first case was a 45(ish) year old man who had been hit by a car. After being greeted by 35 doctors, nurses, and techs (no joke) it was pretty apparent that he was just drunk. Plus he insisted that it was only the mirror of the car that hit him leaving a scratch on his arm. But, there was also a wound on his forehead and he was showing signs of discomfort in his chest. All pulses were strong and equal bilaterally. Breath sounds were unremarkable. The entire physical exam had no findings. Had this guy been sober, they would have cleaned him up and sent him home, but Dr. H. ordered a CT scan. Lesson #1: you can't get an accurate history or list of symptoms from a drunk person; just to be safe, scan him.
As it turned out, the patient had a pneumothorax, or partially collapsed lung, that required a chest tube to be inserted (graphic video, start at 6:15). The fourth-year student, guided by the chief resident, went through the procedure to evacuate the air that was collecting outside of the patient's lung in the chest wall by inserting a plastic tube between two of the patient's ribs. It was actually awesome to hear the rush of air come out when they finally poked through the chest wall. Nice! Our second trauma of the night was a 30-something year old man who had been stabbed in the back while, "walking down the street minding [his] own business." (Which sounded oh so familiar from the case I saw back in March! Still the most dangerous thing to do in Baltimore!) This man also required a full body CT scan and also had a pneumothorax, requiring another chest tube, which was actually perfect for the sake of my learning. Having the opportunity to see the same procedure done twice in a row was nice because the first time I was just barely following the steps, but the second time I was able to anticipate what came next and understood the whole procedure better.
The fourth-year student and the second year PA (physician's assistant) resident then prepared the sterile field and sewed up this man's wounds on his back. And that's when I realized that I only have to wait 1-2 more years to do procedures!
