How's everyone doing on extern?! :-)

Hey!! I hope everyone is doing good and learning lots on extern! :-) lol I definitely am! I LOVE my extern here in Boise. It's been soooo hot here the past week (like 106 degrees) but I think I'm finally getting used to this hot weather. Lol I have been on extern for 1 month and have learned soooo much its crazy! I have been involved with bubble studies, difinity, TEE, pediatric echoes, ICU, CCU, 2 code blue cases, and last Tuesday I went into the cath lab and watched an ASD closure. It was AMAZING! :-) I am now scanning inpatients and outpatients and my CI checks my work after I am finished! I feel like I've already learned so much. Also, last Thursday I got to scan my first pediatric echoes in the NICU. A 2 day old baby (with PS) and an 8 hr. baby (with an esophageal hernia). I LOVED scanning the babies! They were adorable lol well I better get going! talk to ya guys soon!

Boy Oh Boy

These past few weeks have been very busy for me. I have been seeing everything and anything that i could possibly see. I have been in peds cases, adult, TEE, ER, Bubble, Definity, and everything else. I am just starting my job as an PRN EKG Tech here in the hospital in addition to the Externship. I am scanning like crazy but i think that i am being quizzed more than i am scanning. I have started running my own TEE's, with supervision of course (cardiologist) :) The techs down here are happy that i have been able to catch on so fast, cause we have been really short these past couple weeks and they really appreciate it when i can take the paperwork and put it in the computer for them, or take a patient back to the room and get them ready for the echo. I have been putting in 11 hour days the past week but this week i have had the pleasure of working 12 hours a day. Gotta Love it :)

Salt Lake has been really hot these past weeks, in the 100's. I am so happy to have an apartment with air conditioning. I was so happy to see the rain today because it cooled off our 105 degree weather today.

Oh another thing that i have found out about dear ol' Utah is that July 24th is a Holiday :) Pioneer Day's celebration is bigger and more extravagant than the 4th of July. Im so happy that i get to see fireworks twice in one month. Plus, down here you can light your fireworks a week before and a week after the holidays, so really i get fireworks all month long:)

Hope everyone is having a fun time on Extern:)

Woo Extern!

Things have been pickin up on externship. Finally getting some scanning time in after mastering their worksheet they turn in to cardiologists. It's a lot of fun to scan pathology. It's sad for the patient, but it really makes me interested. I still enter everything into the computer and take numbers, but they send me ahead to start a lot of inpatient exams, and if it's really busy i'll be sent down to the department to start on outpatients while the other techs finish other exams. I've seen everything from TEE, to stress testing, to surgery, to MRSA patients. I even had to hold an AMS MRSA patient's hand. I took a shower after that one. This week i even get to go see a robotic surgery and we're trying out a bicycle stress echo with contrast injected through the foot. Should be pretty interesting to see how we're going to actually complete that exam (seeing as how the foot is strapped down and completly covered). If anyone's actually reading these how much 3D echo do you use? My CI is working a full volume quantification into the regular protocol after he went to a conference. It's really interesting. :) Anyways, I love extern a lot and am a lot more focused than i could ever be in a classroom environment. Hope everyone's doing well and having a lot of fun!

Kyle

Code Blue in the ER!

I was sent down to the ER to do a stat echo... the technologist was coming down to met me shortly after he finished a follow-up difinity study, he wanted me to get it started. When I checked my order in the chart I noticed that she was DNR. Her indication was CHF with a history of a recent MI. Well, her LV function wasn't very good and her EF was in the 30's... the ordering cardiologist stepped in while I was scanning and asked how it looked, I explained the LV function and showed her what I had. She noted that it didn't look very good. She left and I continued to scan. The tech watching over me showed up and as I was showing him the images I was getting she went asystole and coded! Her EF immediately dropped down to about 10% Everyone rushed in but since she was DNR they pushed a few drugs and tried to get a rhythm. It was pretty intense but I was cool as a cucumber. The cardiologist jokingly gave me a hard time asking what I did and another ER doc responded that I was pushing too hard :) (I definitely wasn't) It was pretty crazy to watch her heart slow down and pretty much stop, her apex was the only wall segment even trying to contract.

Anywho, everything is really fun here, they trust me to do studies by myself so I am doing full echo's and the write ups, while they just check... I'm pretty sure I should just get signed off on regular 2D stuff :)

Hand cramps & Happiness

It's great to hear how excited everyone is about their first week of extern. We are really out there spreading our wings. :) I'm hoping that as you read this that you too have ice on your arm & hand as I do. Super sore from scanning sooo much, but I'm loving the pain.

Needless to say I've been staying super busy at UCDMC. I've been doing only in-patients. Basically I complete the Parasternal long and short portions of the exam and then the tech I'm with for the day does the rest. I've been getting used to my new Phillips, its really user friendly and has some amazing functions. We just got a new GE Vivid VE and I can't wait to use it next week :). We don't do any history or phy eval on our patients so two of my columns are completely blank but it sure does make my job easier, lol. But I do have 30 completed exams and I've scanned on all of them.

I hardly ever see a normal echo. Every patient has some kind of pathology. Today I got to scan an aortic aneurysm that measured 4.9... WOW. It was the coolest thing I've ever seen, but I felt bad for the patient because he couldn't even speak English (That happens a lot at UCDMC). We see tons of AS and MR. Effusions are super common also. I've already been fighting the bulge with some patients. Many 400 and 500lbs patients :(, after Ive been pushing with all my force I feel as though my hand might fall off. We usually end up using definity on those patients. And the cool thing is we get to make the call if we want to use contrast and we inject it too. I have yet to get my hand stuck under a pancake boob but I feel that its coming in the near future.

I absolutely love everyone in my department. We have many different personalities and different styles of scanning. Some of the ladies have 30 years of experience and some are new graduates. I'm really hoping I will get hired on because they feel like family already. The cardiologists are amazing and very welcoming. Today I got invited to a lunch conference with them (I am very honored). I'm starting to teach one of the fellows how to scan... who would think that I would teach something to a doctor, weird, but super cool.

Well, I better get to bed and get some quality rest, I've been getting up at the crack of dawn all week and I cant wait to sleep-in tomorrow morning. :D

-Ash G

Day 3 at Renown!

I've been doing a ton! My ci has barely spent an hour with me but I've been super busy with all of the techs in the echo/vascular lab. Anna and I get to spend quite a bit of our time together in between scanning(lunch breaks and write-ups). My first two days I did all of the patient set up. Bringing back the outpatients and asking about why they are there(symptoms and history), hooking them up to the ecg and taking preliminary images for the tech.

Today was a lot more exciting because I got to do two exams completely by myself. The tech watched and made sure my images and measurements were up to her standards. She kept saying how perfect I was doing and how impressed she was :D

I scanned an in patient with a history of near syncopal episodes. When I scanned her psax@ao I found a large mass in her RVOT. I pointed at it with the tech watching over me, she said "uh huh" but apparently she didn't notice what I was pointing at, she thought I was pointing at "junk" in the pericardium(apparently possibly coagulated fluid from a prior infection). So when we were going over the exam later back in the lab I asked her what she thought it was. And she hadn't even noticed it. She was quite bothered that she missed something that big because we only got it in that one view so we could 100% say that it was a mass. We asked around the lab though and everyone agreed that there was definitely something in the RVOT. We added a note to the cardiologist that a TEE was recommended. I'm interested to follow up on that patient because one of the tech said she had something similar last week in a different patient and it turned out to be cancer.

Later on today, we had a patient that needed a bubble study. She was post-stroke and we needed to rule out a PFO or ASD. The tech was so impressed with my scanning that instead of calling up another tech to help her she had me do the imaging while she pushed the agitated saline. It was amazing and I did a really good job getting images. Plus the pt did not have a PFO or ASD so we were able to rule that out. I finished the rest of the exam while the tech watched and made sure I did everything right.

All in all things have been really exciting and fun. Everyone I work with loves to included me and teach me. I already feel like I'm improving immensely and it is only day 3!

I'm Exhausted!

So I just survived my second day :) I rode my bike to work, wiped the sweat from my forehead, changed into my scrubs and started scanning! I scanned yesterday too, one of the tech's handed me the probe and said, "show me what you can do." Then he drilled me on tons of stuff and I had major mental overload. I've seen one pediatric patient, two open-heart surgeries, two ER cases, one code blue, and a whole lot of ICU patients. I've scanned a cancer patient as well. I've seen stress, TEE, and saline injections. I wheel the machines everywhere in this really confusing hospital and am introduced to tons of people that I can't for the life of me remember! It's been really fun though :) I come home, talk to people on the phone, work-out, eat and sleep. I'm too tired to do anything else lol. Anyway, that's my experience so far. Hope all of yours are great too!