Days 1 through 4 of Emergency Medicine - Sean

Emergency medicine is interesting because you never know what you might come across. I knew this going into this week's rotation, and so I was hoping to gain experience dealing with many different types of cases. What follows is a summation of the main events of each day.

Day 1
This entire week, Mariko, Viet, Jack, and I were scheduled to be in the Emergency Department under the same preceptor, Dr. Lee. It turns out he had organized a curriculum for us to follow throughout the week working with different attending physicians in different areas of the Emergency Department. The first morning we received an orientation from one of the medical residents, Dr. Shih, who gave us a quick rundown of what we would do, where we should go, and who we would work with. We were dismissed after that until the afternoon where we reported to Dr. Lee (a different one) in the 2nd and 7th observation areas.
We were able to see several patient with various chief complaints that afternoon. GI pain, cellulitis in a patient's face, dizziness in a stroke patient, abdominal pain, and vomiting were some of them. At one point, Dr. Lee had to leave for a few moments, but left us to figure out the diagnosis of one of his patients based on the history and symptoms. Using our "resources", Mariko, Jack, Viet, and I deduced that the patient had acute bronchiolitis. We were somewhat correct, but since the patient was an adult, it was more likely that it was bronchiectasis.

Day 2
It was the four of us again, except this time we were told to come in early for a joint department conference between the Emergency Department and Internal Medicine Departments. They did a case presentation of the same patient, except specific to the time that patient spent in each department. The meeting was in Mandarin, so I was not able to get that much information from the meeting, unfortunately.
In the afternoon, we were in the 8th observation following Dr. Tsen. Again we saw several patients here, but this time they were new patients arriving in the ER. Some of the cases included: thrombocytopenia, abdominal pain and lack of bowel movement for 3 days, dizziness and headache for 1 week, and cellulitis of the foot. The patient that was experiencing dizziness and headache for a week was actually a young Vietnamese women. Since she was more comfortable conversing in Vietnamese, our one and only Viet Tran volunteered to obtain a history of the patient's present illness. Dr. Tsen would sometimes have an extra question or two to ask, and so Viet translated to her and back. Towards the end of the day, we were able to witness a trauma patient that was brought in by the EMTs. From what I could take fro mthe situation, an elderly lady was working in the street when a truck ran over the lower part of her right leg. The situation was very intense because I could see that the woman's skin was partially ripped from the leg, exposing her calf muscle and many of the blood vessels in the region. Amazingly, there was not as much bleeding as one would expect. The physicians feared that she may have internal bleeding in the abdomen from falling and were waiting for an echogram to screen her. An orthopedic surgeon and plastic surgeon were summoned for a consult to assess for any broken bones and to plan for reconstruction of the skin.

Day 3
There was another early morning meeting today. This meeting was specific to the Emergency Department and involved another case presentation. Breakfast was provided, so that was pretty nice :). After the meeting we were dismissed until the afternoon.
We returned to the ER to meet Dr. Chen and followed him to see his patients in the 1st and 12th observation areas. Some of the cases in these areas were more complex than the previous areas. They ranged from CHF to acute pancreatitis to malignant neoplasm of connective/soft tissues to skin infections to cerebral artery infarcts. Most of the patients in these areas were at the hospital for at least 1 or 2 days already, so they were receiving extended care. I learned that because of the health insurance in Taiwan, patients can stay in the ER for as long as 2 weeks and pay only 750 NT (~$25) no matter the type of care they receive. Pretty ridiculous, especially for the cases that did not seem as serious. Yet the patients have the right to stay. Suddenly it became clear why the ER was so crowded and why there are so many observation areas.

Day 4
Dr. Luo was the physician to follow in the 1st treatment area this morning. Overall, these patients had the more critical or life threatening conditions. Patients that came in with symptoms of shortness of breath, chest pains, or a known morbid disease were placed in this area of the ER. IV bags were hanging all over the room, and nurses were constantly administering meds and other means of care. Dr. Luo showed us several of the patients' radiological images as he tried to explain the diseases at hand. The residents in the ER also tried to help orient our confusion over different disease presentations and treatments, like for SLE. This area was definitely more fast-paced than the observation areas.
The 2nd treatment area was where patients that arrived in the ER with less critical conditions were sent. This, of course, meant that most of the traffic in the hospital came through here. We finally were able to meet the organizer of our curriculum for the week, Dr. Lee. Since the area was so busy, we were split amongst different physicians. Lucky for me, I was able to follow Dr. Lee first hand. I was totally amazed by the speed of how he dealt with patients, both effectively and compassionately. I could sense the tension he faced in getting through the constantly growing list of patients, but at the same time I experienced his genuineness when I listened in on his conversation with patients. My major impressions of Emergency Medicine comes from observing Dr. Lee. He told me it was a specialty full of tension and excitement, and that I should expect to be constantly challenged with a varying symptoms for every type of case.