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Hammer168: ER 志愿者第一天
作者:USMedEdu
发表时间:2008-01-04
更新时间:2009-05-27
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发信人: Hammer168 (Hammer), 信区: MedicalCareer
标 题: ER 志愿者第一天
发信站: BBS 未名空间站 (Fri Jan 4 20:45:10 2008)

Last evening, 4pm, accompanied by volunteer manager, I walked in ER in a
local community hospital. She introduced me to doctor A. Doctor A introduced
me to the other doctor B after a while. In the beginning, I was seated in
the headquarter area, where a flat screen, in replacement of conventional
blackboard, catching the spotlight. It was real awkward in the first 30
minutes. Doctor A told me to wait there while he’s clicking on their
charting system (It was similar to Step 3 CCS, perhaps slightly better
designed for the ER.) and promised me to show me something interesting later
. Well, what can I do? I found a smaller screen to stare at. It was the EKG
monitor for all the patients admitted. It kept sending out alarms. A young
guy C told me not to worry about it. C was the operator. He took all the
calls from outside in addition to filing.

After the first 30 minutes, people there generally accepted me as an
existence, although I still felt awkward. Doctor A probably noticed my
ignored比state. He came to me and discussed with me a back pain and chest
pain case. There was ALK Phos up. No liver enzyme abnormality and no calcium
up. XR showed osteoporosis somewhere before. He asked what problem the pt
might have. I gave him a few diseases. Through the talk, I found him also an
IMG likely from mideast and his medical knowledge was solid. After that, I
sensed more acceptances around there. I started to ask questions to the
nurses, who responded nicely.

Doctor B asked me if I wanted to go with her. I said “sure”. An old female
, SOB. She asked about the history briefly and discussed the advanced
directive with the relatives. After listening to her chest, she suspected it
might be a pneumonia case. 10 mins laster, she asked if I wanted to go with
her for the next case. Again, I followed her. It was a case about old women
with tons of problems, rheumatoid arthritis, osteoarthritis, COPD, CHF,
Alzheimer's… She fell several times in the last 3 days with back pain and
lost bowel control. During the discussion of the case, I felt doctor B got
offended somewhere. Maybe I didn’t politely ask before interruptions during
her clicking on the screen. She ordered MRI for her. I asked if it was
spinal nerve injury… (before I got into sleep at night, I thought of NPH or
subdural hematoma as the reason, perhaps she thought I was unqualified MD
for that) After that, she didn’t ask me to follow her. I was wondering what
would happen if I asked to follow her.

About 9pm, an arrhythmia pt came. It turned out to be inferior wall MI.
Classic EKG pattern. Doctor A called 2 other doctors to come over to help.

About 9:45pm, before leaving, I thanked both doctors A and B. They wished me
good luck kindly.

总结, 1. 跟班是不容易的. 2. ER 可以见到很多病例. 3. ER 医生好像不太难做可能
会比较累. 4. ER 医护配合默契.
我好像图新鲜的成分很重. 也不知这后面怎样走才合理. 感觉上社区医院不太注重教学
. 一个星期去一趟给他们打打杂倒也可以. 最好还是得找个可以上手做的医院.
--

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