A Saturday at Mary Rutan ED

Today I worked in the Emergency Department from 10am-8pm, a nice Saturday in the ED. Most of the cases could have waited to see their primary care physicians on Monday or Tuesday (sore foot, headache, etc), but we did have a few legitimate ED patients (although, not emergencies): a split finger that had to be sutured (I did the suturing), a fifteen-month-old with a broken elbow from last night, and a nine-year-old with a Jones fracture (break of the metatarsal of the pinkie toe). Oh, and I diagnosed the Jones fracture (with the right name and everything), so I was feeling rather proud of myself. The girl, though, is probably less excited--six weeks in a full fracture boot and crutches.

Here's an x-ray of a Jones fracture (not my patient, but you get the idea)

And, of course, there were the ones that shouldn't have gone in to see a doctor at all. We had a 21-month-old girl brought in by her mother because she got stung by a bee on her ear. No, she didn't have a bee allergy. She had never been stung before. But her ear started to swell, so her mother brought her in to make sure she's going to be okay (she is). We also had a 22-year-old girl come in with cramps. Yeah. That was fun.

Of course, there were a couple of patients that just go to show why fourth year medical students must be supervised. There was a man in his seventies with metastatic cancer, complaining of cough and chest pain. So, he got a chest x-ray, which the doctor was able to tell right away what was wrong. I could tell that there was something not right, but I had no idea what it was. The doctor tried giving me hints, but I was oblivious. It turns out that the area that looked a bit off was a Westermark sign, which is indicative of a pulmonary embolism. Here's an example of a Westermark sign:

If only my x-rays came with labels like this one... But sadly, they do not, which tells me that I have to brush up on my radiography, which does not make me happy.

Next shift... Tuesday, 8am-6pm.