ED senses...part 2

***so continuing my disclaimer about this series - likely slightly graphic and descriptive
hide yo children, hide yo wife...

3. smell - there's a lot of smells in the ED as you can imagine.  homeless people, stinky feet, stinky "other parts"   one distinctive smell is an infected wound - especially if its infected with a particular bug called pseudomonas - one look and one whiff and your on your way to an antibiotic cocktail and a bed upstairs.  it has this unique quality.
then there's C. diff - its this awesome watery diarrhea from overgrowth of bacteria in your colon - it got one of those pungent distinctive rank to it.  the kind where the vomit just gets to the back of your throat.  i must say, i've proudly never actually puked in a patient's room in the ED.  I've come really close before once when i was doing a rectal exam and got such an explosive whiff and a little bit of results that it nearly had me chunkin in the corner.  thankfully some composure and plenty of laughs outside the room - whew, close call.  that's not saying i haven't puked at work.  one time back when i was a surgery intern i once puked 3 times in a patient's room while i was trying to examine her.  even she told me to go home - too bad that wasn't really allowed.
there's one more distinctive odor worth mentioning - the infamous foul pelvic exam - usually BV's the culprit - this is where you merely have to walk in the room to do the pelvic without actually having to do it to know what's going on.  In medical school they teach something called the "whiff test"  where you are supposed to smell the vaginal discharge - if it smells "fishy" then you've got a ringer - no need to send it to the lab.  nice and gross - i don't usually take it to my nose and whiff - the view and waft is usually all you need. 

4. touch - this could be so many things - i'll probably keep it simple though.
some are simple joys - like when you feel a strong pulse of the patient's own heartbeat after some CPR - those are good.  even if they only last for a little while.  the indistinguishable clunk of a shoulder or hip reduction after its been dislocated from its socket.  most are not so good.  the opposite feel of no pulse in a cold leg, the cold clammy skin of patient dying of sepsis (bacterial overgrowth in the blood), the numerous amount of times a day i have to give a rectal to feel a prostate or check for blood (neither participant likes that part - despite what you think) - amazing i can go to so much school and i still get to stick my finger in places where the sun doesn't shine (most of the time)

5. taste - i can't say i taste much of anything in the ED - did you know in the old days they used to sip patient's urine to see if it tasted sweet and they were spilling glucose (sugar) out in their urine.  awesome - thank goodness for the lab.  not sure i'd see many patients if that was part of my repetoire

i'm starting to sense a theme....