Imposter!

Today is the first day that I felt truly overwhelmed in the ER. I'm with a different preceptor since my normal one is on vacation, so I'm out of my element anyway. Just for kicks, s**t picked today to hit the fan. Here's what I had today (as in, they were in my room and not just patients that I poked my head in on):

• Intoxicated heroine user who repeatedly banged head against wall and tried to escape the ED. We didn't put her in mental health, because her sister was on her way to get her. Was never EP'ed, so security refused to sit with her.
  
• Code blue in progress, ended up calling it 10 minutes in.
  
• Unresponsive man found at his home, agonal breathing, O2 sats 60-70% room air. Awake on arrival. H&H of 7 and 28. Probable GI bleed.
• Massive STEMI. Gave lopressor, heparin, integrilin, plavix, and ASA. Up to cath lab.
• Helicopter trauma patient, assaulted and found unresponsive facedown by EMS. Celebrating a little too hard for St. Patty's day, discovered that at the end of the drunk rainbow, there is no pot of gold. Only lots of fists from those beating the crap out of you.
• A severe mitral valve prolapse patient, chest pain with dizziness.
• Teenager with severe Crohn's Disease, might need surgery. Jackass for a mother.

I think I'd be able to handle one of these at a time, but trying to take on three serious to critical patients at once is just overwhelming. I sort of know what I'm doing, but not enough to feel confident in myself. I've been told that the ED is one of the hardest places to start out, and I'm finally feeling as incompetent as I bet I look.

Let's just hope tomorrow is a better day!