Anesthesia interupted

I've actually only spent a day and a half on the first half of this rotation. About ten days ago I thought I had the start of a case of phlebitis in my right leg. The anatomy there is a bit messed up after a crush injury 20 years ago. But I've had no problems following a fasciotomy, bone graft, skin graft, internal/external fixation and five surgeries.

So after my Critical Care post-rotation exam on Tuesday I went to the local ED expecting some imaging would be required to figure out what was wrong. They did a full leg ultrasound and found nothing (good news). So I left with a copay for $150, a prescription for Keflex and a diagnosis of cellulitis. It was just starting to get red and warm so this made sense.

Wednesday stayed home while I continuing my regimen of warm compresses, elevation and aspirin (plus the antibiotic) because the pain was worse, even excruciating whenever I tried to stand for more than a few seconds.

I attempted to work on Thursday meeting my Preceptor at Arizona Heart for a 3-vessel CABG. After I intubated the patient, my Preceptor noticed that I could only observe for a few minutes
before the pain got too much. So I showed him the now very red muscle compartment where I had had the fasciotomy. He sent down the wound clinic where I received a second antibiotic, Bactrim, in case the infection was MRSA. The Doc said it wasn't fluctuant but could turn into an abscess anytime.

Thursday evening I noticed the first sign of puss with a little whitehead like dot on my skin. By Friday there was frank puss under the surface of my skin, but the red area had shrunk. The pain was still excruciating when I tried to stand. So I went back to the ED for an I&D.

It fun talking to the ED physician about my starting at UConn shortly, however she only checked out the cellulitis and added Clindamycin to my antibiotic cocktail. Her PA (Physician's Assistant) actually performed the I&D and she was vicious. One stick, but she jammed the needle in to the hub and pumped the Lidocaine in hard. Then she stabbed into the muscle (which without the overlying fascia, was just beneath the skin and abscess). No mercy. Worse, she one of those prissy, attractive Scottsdale types. No bedside manner.

I have to return tonight to have the packing taking out and make sure the three antibiotic cocktail is working. I hope she's not on, or I may have to request someone else.

So I really only saw two surgeries this week. A very long and interesting cervical laminectomy and vertebral fusion on Monday, then bits of a CABG on Thursday. At least I successfully intubated on the latter. The highlight of the week though, was getting a Pass on that Critical Care post-rotation exam.

It goes without saying, I hope I'm well enough to do more during my last week of medical school education. My Preceptor is great, so I hope to learn a lot and get in a few more intubations.