History and Physical Write Up
Journal Article
Lim2016 – Patching for corneal abrasion
The patient I presented at my site evaluation suffered a corneal abrasion. One of the questions I had asked my preceptor for that day was whether or not we should patch the patient’s eye to promote healing faster? The preceptor instructed me that they were never taught to patch corneal abrasions. So I did some research and found a systematic review revolving patching and its impact on pain relief and the healing process for corneal abrasions. 12 trials were included in the review with over 1,000 patients participants. Patients who received patching were less likely to have healed corneal abrasions after 24 hours compared to those who did not receive the patch. Similar numbers of patients whether in the patch or no-patch group had their corneal abrasions healed by 48 hours. No evidence to suggest altered levels of pain between the patch and no-patch groups. Overall, simple corneal abrasions treated with a patch provide no improved healing times nor does the patch reduce any pain for the patient.
Site evaluation: My summary
It was my first time speaking with professor Seligson. She is very kind and it was obvious after the first site evaluation that she was very knowledgeable having worked in the ER. As someone who is really considering working the ER, she was definitely someone I enjoyed talking to about my HPs and thought process to certain patient presentations and I was also able to bounce some general questions I had with which she was happily able to provide me with details and her own opinion on things. The patient I chose to present for my second site evaluation was a patient who suffered a corneal abrasion. The patient was a 25-year-old, male, with no significant PMH, who presented with a foreign body sensation in his right eye x 1 day. Pt states he works as a welder, believes that yesterday he saw a spark fly backwards towards his face and is concerned it may have gotten into his eye. He reports not wearing protective goggles at the time. He immediately flushed his eye with warm water for 15 minutes afterwards. Pt states he is a contact lens wearer and was wearing his contacts at that time. He has been using OTC Visine Eye Drops with minor relief. After further questioning, it was discovered that the patient typically wears his goggles/mask but just so happened to not wear them at the time of incident. After irrigation of his eye with sterile normal saline, a fluorescein stain was performed and under the slit lamp, the corneal abrasion roughly 2mm in length was ~ 3mm inferior to the pupil. Since the patient was a contact lens wearer, we prescribed Tobradex for the patient to put a drop in his eye every 8 hours for the next 2 days just until he follows up with ophthalmology. During my ER rotation back in March, I did not deal with many any eye complaints during my one month rotation which was so strange. Working at the urgent care, I dealt with a plethora of eye complaints and wanted to present a case about a patient that I normally do not see.
Typhon postings
Self reflection
I really enjoyed my Ambulatory Medicine rotation at Center Urgent Care in Middle Village, Queens. The preceptors (DNP or PAs) were very friendly and were very willing to teach. As a student who is interested in the ER, rotating at an urgent care really allowed me to practice on skills over and over and over again due to the patient traffic we would see on a daily basis. ~ 200-300 patients were seen everyday, a lot of them solely for rapid/PCR testing, but the other half were all “sick complaints” in which I was able to go in and see what was going on. I did not know what was going to walk into that urgent care and that was the fun part. I got to practice some skills
Exposure to new techniques or treatment strategies
Something I did not get to do a whole lot in the ER was suturing and I&Ds. I sutured a couple times in the ER, but was not given the chance to perform I&Ds at all. At the urgent care, I was expecting 2+ abscesses per shift. I was introduced to using 11 blades versus 10 blades since they were much more sharper and easier to slice open the abscess. I was also taught how to perform digital blocks and when not to use lidocaine w/ epinephrine [nose, fingers/toes, and penis] due to possibility of necrosis from the vasoconstrictive properties of epinephrine. I was also introduced to disimpacting ear canals and in treating subungal hematomas. It was a great rotation for which I was able to apply knowledge day in and day and was also able to perform lots of procedures each shift.
How could the knowledge I’ve gained here be applicable in other rotations/disciplines?
One thing I noticed was that the urgent care can get very busy. Being that there is only one sole provider, I can see how it can become overwhelming, especially if the complaints are not so simple and straight forward and just so happen to all arrive at the same time. Urgent cares are known for being quick and having short wait times, but once the urgent care is busy, wait times and patient stay can increase a bit. Being a sole provider, managing patients based on severity of their complaints is one time management skill to have. Typically patients are seen on a first come first serve basis, however, you may want to see the patient with a “sore throat x 1 day” first, evaluate and discharge, versus seeing the patient who presents with “back pain x 4 months”. In the urgent care setting, you never want patients to wait longer than they have to because it could then feel very overwhelming as a provider knowing you have 10 patients waiting for you and they all have not been seen yet. In future rotations and even in life, time management skills/prioritizing patients can really help a provider have an easier flow to things which in the long run, if better for patients where the provider will not have to feel as if he/she is rushing where mistakes can happen.
What was a memorable patient or experience that I’ll carry with me?
This was towards the end of my rotation, by this time, I had given more COVID vaccines than I could count. I saw on the EMR that the patient in room 1 was ready and they were here for the first COVID vaccine. The second I stepped foot into the door, the young woman was petrified. She was not scared of me, but the fact that she was about to get the COVID vaccine. The patient suffered from rheumatoid arthritis, recently had a flair up in her shoulder, and was hearing mixed information from friends/colleagues about the vaccine. The woman was shaking and began to cry. This was exactly where I applied the Interviewing and Counseling skills that Dr. Davidson had taught us and tried to get to the bottom of why she was so scared to get the shot. The patient truly did not know anything about mRNA and how it works, she was petrified of the side effects she has been hearing about, the pain she was going to feel and she was so scared she was going to have an allergic reaction to the vaccine. I spoke calmly, gave her my full attention, and politely explained what the vaccine was for, how it worked, the common/not so common side effects, and the reality that she most likely would not have an allergic reaction to the vaccine since she has never had an allergic reaction to any vaccine in the past. I reassured the patient that she will be fine, I gave her my own experiences with vaccine and that truly calmed her down. I kept talking to the patient as I quickly administered the vaccine. The patient did not even notice it had been administered. The tranquility she experienced afterwards was very rewarding for me to see because I had just turned this woman’s anxiety and panic into and peaceful state of mind. She was so grateful that I had talked to her and made her calm down that she even said grate things to my preceptor that day. Even though this was not a miraculous life saving event, as a healthcare provider, sometimes our best medicine is a simple conversation.
