Two nights ago a man came in with a broadcomplex tachycardia very suspicious of VT. I called the cardiologist and ordered iv amiodarone. As the amiodarone ran in the man become more and more anxious with severe chest pain. Badly circulating I figured he needed electrical cardioversion. The cardologist wanted to give the medicine more time.
After two hours both the patient and I were done with it. I called the cardiologist back and told him I was going to cardiovert. The anesthesiologist came in and I set the defibrillator for 15 J. Never having done an actual cardioversion for VT I figured it could not be hard. He converted after the first shock.
Last night a bodybuilder came in with a dislocated shoulder. I gave him local anesthesia and a sedative and tried to reduce the shoulder. After ten minutes of traction-countertraction the shoulder still would not budge. Even with a different technique the shoulder would not give way.
The thought of having to call someone and explain how I, a board certified Emergency Physician, was unable to reduce a dislocated shoulder was not great. So I got out Tintinalli and looked for a third method. The external rotation in adduction with a successrate of 78% sounded great. It took two attempts and the shoulder popped back in.
I do not see myself as a great doctor but I am definitely trying to become a better one every day. It is not about the things that you know how to do, it is about not knowing and coming up with a solution. Lazy cardiologists and muscled guys with shoulder dislocations, bring them on any time.
