Procedures

Emergency medicine is a very hands-on specialty. I've gotten a couple of really good procedures in the last few weeks. I'd never reduced a shoulder dislocation, but orthopedic complaints are common ED visits. We did two reductions of anterior shoulder dislocations under conscious sedation (which was fun in itself given the anesthetic nature). One was tougher, requiring two people and two sheets. The other was incredibly easy; after getting the gentleman to relax, the shoulder popped right in with minimal external rotation; I hadn't even started abduction yet.

I also got familiar with lumbar punctures, which I hadn't done very much previously. Meningitis is always a concern with patients presenting with fever and headache, so there's a low threshold for doing LPs (or spinal taps). While I had trouble with the first two, the one I did yesterday went incredibly beautifully. Like everything else, the set-up is the most important aspect and after getting the patient positioned optimally, I slid the spinal needle in smoothly and got clear CSF.

Finally, for the sicker patients, I got to do a central line and even a cardioversion. I'd seen patients shocked in codes, but there's always so much commotion it's hard to tell what's going on. For this older gentleman, a time of onset of his atrial fibrillation was determined so we were able to cardiovert in the appropriate window. Anesthesia came down, gave a slug of propofol, and we sent a jolt of electricity through his body, and I saw a beautiful conversion from rapid atrial fibrillation to a sinus rhythm at 50 beats per minute. These are great moments in the ED.