Emergency medicine in an urban community emergency department

I have started a new rotation! I am working at an Emergency Department in a community / urban setting. Today my Emergency medicine shift at urban community emergency department was extremely busy.  So I had several patients today that were very interesting in nature.  It started early in the morning and it was busy right when I got there.  

First patient was an anaphylactic shock for a bumble bee sting to the hand that required some sub q epinephrine to prevent worsening of the anaphylaxis.  I had another patient, I'm not going to tell about all of them, but this patient had a panic attack, he was a young male who had recently quit smoking marijuana, he was kind of having a paranoid / panic attack.  I also had a family who had some stomach gastroenteritis and vomiting, stomach pain, and diarrhea. I had a four-person automobile accident trauma brought in by paramedics.  The driver was a 23-year-old female who had been driving her nieces and nephews.  There was total of four in the car going, I don't know, she was traveling at about 60 miles an hour, ran into another car then bounced off the median.  All of them were in seat belts and remarkably all of them were fine.  The driver was the worst injured.  She lost some blood due to a large laceration on her forehead that was about 6 centimeters in length, and a laceration on her nasal bridge.  The forehead laceration required four 4-0 vicryl sutures that I buried the knots to bring the forehead laceration together, and then I threw about eight 6.0 ethicon nylon sutures to close the forehead wound and additional sutures were needed for her nasal bridge laceration as well.  Fortunately for her all of her CT scans of her head and neck and chest and pelvis were unremarkable, no abdominal perforations or head bleeds or broken bones.  We also did several X-rays and there were no broken bones but she was pretty shaken up.  A 10-year-old, a 5-year-old and a 2-year-old in the car as well who also had various injuries but nothing life threatening.

I had a gentleman who came in, an older gentleman with an acute attack of gout which required a procedure.  I had to put a needle into his knee to tap I delicately inserted a needle into the joint space and was able to get the fluid out so I could send it to the lab. The lab was able to analyze it and it came back and it turned out to be a flare up gout rather than a septic knee.  I also had a couple patients, that were not too interesting, just an alcohol intoxication and a drug overdose that both needed medical attention. 

A lady came in with severe mouth /  tooth pain.  She had a dental abscess and had been turned away from five dentists' offices because of her diabetes and hypertension.  I was able to examine her and determine that in fact she did have a tooth that has essentially decayed down to the root and really needed to be pulled but she had an abscess and some severe 10 out of 10 pain.  I was able to give her I.V. pain medication in addition to a nerve block in her mouth to block the pain that was causing her to almost become suicidal so she got a regional nerve block in her mouth and a nerve block around the tooth and abscess itself which helped her tremendously.  So this was a crazy shift where I saw at least 15 patients with varying ranges of acuity from pretty moderate/mild to near life threatening.  

That was the day in this urban community emergency department.  This particular emergency department does not have other residencies so as an emergency physician in residency, I get to do most of the procedures whether it's an incision and drainage of an abscess or a vaginal issue that needs to be taken care of, we don't call the other specialties, we just do most of the procedures and handle it ourselves.  So that was my day and I am sticking to it! We will see how tomorrow goes. It will be just as busy and probably just as crazy. It is just how Emergency Medicine goes, and I happen to love it.