Pulmonology

Day 1

Well, it was a half-day today since the doctor closed afternoon clinic due to a possible tropical storm (which died down and ended up being good weather today). I was fine with a half-day since I have a ton of studying to do for the shelf exam (in a week from now - yikes!). The pulmonologist is also an intensivist (ICU doctor). It was a light morning so we saw 4 patients together and I did the physical exam - which was mainly listening to the lungs ( & occasionally paying attention to the heart and extremities).

Things I learned:

What do you look for on a patient with CHF exacerbation? edema, JVD

What's the first thing you look at when entering the patient's room with COPD exacerbation? VITALS - BP increases, pulses increase, & of course, pulse ox decreases.

Urine output decreases when in renal failure, dehydration.

Day 2

I had pulmonology with a different physician in the morning since the doctor I followed yesterday had meetings all morning. The first 15 minutes was cool. I got to see a bronchoscopy performed and then he let me take hold of the scope to pull it out of the patient while looking at the monitor to see the scope move up the trachea. At first, I didn't understand what he was trying to say as far as how to maneuver the scope. He just handed it to me & very quickly said "this is the up & down button and this is the suction button" I misinterpreted the up & down button as what makes the scope move up & down (it's not like I got to fool around with it before it was in the patient). I'm supposed to use one hand to pull the scope (tube) out manually and the other hand holding the controls to move the camera. I figured that out a little later (this was after I kept pushing the up button & it just made the camera move up towards the wall of the trachea and I guess the doctor didn't know that I was doing that and he told me to keep pushing the suction button and keep the camera in the center - btw, guess what happens when you put a little tube against the wall & push the suction button - it's kinda like a little vacuum cleaner. Once the trachea was back in view, you see this little dark pink circle - don't worry, no damage has been done.) fyi, the scope goes in through the nose and the patient is awake, but they do give mild sedation and some lidocaine once inside the pharynx. You could see a little red light through the skin of the patient as the camera moves down the throat. The doctor saids it usually takes him about 30 seconds to do a bronchoscopy and this patient didn't have anything abnormal.

After that, following him became very boring. He tends to work at a very fast pace and didn't spend too much time teaching. He'll talk about the patient briefly, so I don't feel like I learned anything this morning. I would just sit and watch him write progress notes, orders, and dictate on the phone (he could be an auctioneer. he talks at 2-3X the normal talking speed). He also had meetings that afternoon, so I would follow the first doctor(who I followed yesterday) in the afternoon.

So, overall, I got to see some things a pulmonologist does. Although, I didn't get to see them in the clinic setting.