Sunday, July 24, 2011

The Doctor Behind the Curtain

As the month comes quickly to a close, I reflect on the time I had in the operating room that was definitely an enjoyable experience. At first glance it looks overwhelming, but in time the buttons and monitors have started to make sense. It is no wonder that there is a dedicated individual at the head of any operating table managing a patient's life.

Sweet Dreams

There is much more to anesthesia than putting tubes here and wires there. As the photo demonstrates, there is one tower for monitoring the patient while providing life support and another for the medications that assist in that effort. Poles for fluid resuscitation, suctioning for secretions and gizmos for I don't know what that keep a patient happily asleep. It is amazing that so many tools, gadgets and devices can be crammed into such a small space and have such a large impact. There is barely enough room back there for the physician let alone a student to participate and learn. Despite the lack of space, the attendings continually let me interact with intubations, monitoring and interventional  procedures to get the full experience. These docs run a great one-man show and are so full of knowledge that I often could not keep up.

This niche in medicine will apparently have a 15,000 physician shortage in the year 2020. I hear medical students clamoring to get on board and it seems that the doors may be opening for them. From the physicians who tout the profession, they share their opinion as though it is medicine's best kept secret. They manage only one patient at a time who they rarely seen again, earn a significantly comfortable salary, and between the induction/emergence phases of anesthesia have few complications. On more than one occasion I have noted the relaxed and stressless demeanor of these specialists to be common for the profession. But when patients are in distress, these doctors are collected enough to help carry a patient through more often than not. It has been a good month with plenty to learn.

Question of the Week
A 30 year old male presents to the emergency department with muscle rigidity and dyskinesias. You notice he is mute, incontinent, in and out of consciousness, and febrile. He is diagnosed with neuroleptic malignant syndrome. Which of the following would be least useful in the treatment of this patient's symptoms?

A. Admission to the hospital
B. Replenishment of IV fluids
C. Administration of bromocriptine
D. Administration of dantrolene sodium
E. Administration of haloperidol

Answer & Explanation


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