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Coreg: 我的intern第一天
作者:USMedEdu
发表时间:2009-07-06
更新时间:2009-07-06
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发信人: Coreg (shandong), 信区: MedicalCareer
标 题: 我的intern第一天
发信站: BBS 未名空间站 (Sun Jul 5 22:59:11 2009, 美东)

My first rotation is at GI specialty. It is relatively easier than working
at ward, which includes weekends off, no long call/short calls. My day
starts at 7:00am. The first thing was to the floor to check on the patients
that were consulted yesterday. Make sure that the pts had no acute bleeding;
vital signs and H/H are stable etc.

I was paged at 7:30am. My resident told me to go to consult a patient at ED
with a chief complain of “food stuck in esophagus.” This was a 47 Y female
with history of Hep C and IV drug use. It happened 30 hrs ago. I finished
my consult report with an assumption that it should have been an ENT
consultation. I was still struggling with using the computer system to get
labs and history. The resident told me to meet the team at ICU at 8:30am
because there was a pt there needed PEG tube placement.

The attending asked a simplified H&P. Since I didn’t have any
differentials, I couldn’t answer very important questions that the
attending concerned; drooling? Hx of GERD? He decided to do upper Endoscopy
for the pt. The pt was called to GI lab while we watched the attending place
the PEG tube. During that time, my pager was beeping for a few times. The
nurses wanted me to go down to do H&Ps for outpatients at GI lab. Luckily
the attending insisted that I watched the procedure first. It was exciting
to see how the PEG tube was placed. It was a barbaric procedure. I wouldn’t
want to have it done on myself.

The patient from ED was ready for the endoscopy when we went there. The
attending collected H& P himself and explained the differentials: schatzki
ring, eosinophilic eophagitis, peptic stricture, webs, cancer etc. It was
amazing to watch the piece of steak totally obstructed her lower esophagus
by the GE junction. I couldn’t help but thinking what would happen to her
without endoscopy? Perforation, infection, death. Surgery could be a better
choice.

I attended noon conference and had my lunch from 12- 1pm. The topic was
sepsis.

In the afternoon, I watched that the attending did 2 endoscopies. One of
them was a 50 y Mexican male with a history of fatigue, weight loss for 6
months. He was dx with rectal cancer on the procedure table. The surgeon was
called to come and take a look. The mass was biopsied and sent to path lab.
The pt was admitted to the floor right away.

We took a round of all the patients that needed to be consulted by GI after
that.

The last hour of the afternoon was a lecture of upper abdominal pain. We
could leave at 5pm.

It is a teaching oriented environment. The attending is very approachable.
My residents are supportive. It is very lucky to have all the nice people
to work with on my first rotation.


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