During my site evaluations for this rotation, I presented two cases that I found to be very interesting and offered a lot of learning experience. For my first H&P, I discussed an elderly male patient with history of hypertension, Type 2 diabetes, and adenocarcinoma of the cecum s/p excision of colon and rectum with permanent ileostomy who presented with acute onset abdominal pain and vomiting. His symptoms were most consistent with a small bowel obstruction, which was confirmed by the CT scan. On physical exam, he was in moderate distress, tachycardic, and had generalized abdominal tenderness. For initial management, we gave IV fluids, morphine, and Zofran to help with the symptoms. We also started him on ceftriaxone and metronidazole since his lactate and WBC levels were slightly elevated. Ultimately, we consulted surgery for further management. This was my first time seeing a patient with SBO, so I was glad that I was able to learn how to manage the patient. This case also allowed me to interpret lab values and read CT imaging, as I was able to visualize the dilated loops and air fluid levels on the scan. 

For my final site evaluation, I presented my second H&P on a male patient with history of hypertension, hyperlipidemia, hx of Type A & B aortic dissection s/p aortic arch repair, and hx of dissecting aortic aneurysm, who presented with chest pain and shortness of breath. On exam, patient was in mild distress and tachypneic, with increased work of breathing. We collected labs, performed EKG and POCUS, and gave the patient O2. Given this patient’s history, we sent the patient for stat CT angiography of chest/abdomen/pelvis. Unfortunately the patient coded while arriving back from CT, prompting us to initiate ACLS. CPR was continued for 45 minutes before pronouncing the patient dead. The CT ultimately revealed that the patient had a ruptured thoracic aortic aneurysm. Although this case had an unfortunate outcome, this also brought about an important learning experience for me. It was one of my first experiences participating in a code situation, which allowed me to observe how the team worked together to manage a critically ill patient. Reflecting on this experience, I recognized areas where I can continue to improve, such as improving my skills and clinical reasoning during high acuity cases. It also taught me the importance of teamwork, communication, and preparedness required in emergency medicine. 

Overall, I received good feedback on my cases in areas where I can improve on and continue doing well. I believe that I am starting to organize my H&Ps in a way that is concise and contains all pertinent information. I hope to continue this technique for my future rotations as well.