mercoledì, marzo 30, 2005
:: the big bash ::first, my high spirits took a bashing when the nurses told me my tutor was OFF duty. apparently, he and this other doc switched duties. hmmm... but the other doc, who's superior in terms of looks and probably humour, agreed that i could be his 'shadow' today. anyway, next up is a bashing in the areas of the orthopaedics, medicine and surgery!!! i've totally forgotten aspects of the history, physical examination, and those characteristics of such diseases as pseudogout, cluster headache, tension headache, and what nots. just got grilled and grilled CONTINUOUSLY from 8am to 1pm. where both of us were quite exhausted, me from brain strain and him from brain strain trying to get me to answer his questions... finally, i was so concussed i cannot find the needle i wanted when it was lying right in front of me... took some blood, thank goodness it was successful, at least i'm not as useless. sigh. he just dumped me to set plug and omg, i ALMOST succeeded! but when i was pulling out the needle and pushing in that plastic, the darned thing for STUCK and everything came up, followed by generous bloops of blood all over the place. thankfully the patient was nice enough, in fact, he was more concerned about dirtying the floor than the bloody state of his hand. sigh. thereafter i decided not to risk damaging the other vein on his hand, and got dr to do it instead.
i think it'll be cool when i finally become one, (though right at this moment, the prospect seems to be only possible in my dreams)... cuz the sounds of dr **** still ring in my ears... (the doc's name is similar... i'm gonna be soooo jealous of his tutorial grp!) today the other docs on duty were the one with a blog and she is really easy-going, friendly, and funny! :) and lively... i'm also gonna be soooo jealous of her tutorial grp! the master of antidotes also a very humourous person, heh heh, a bit evil too. ooooh...
some cases i saw today: (mostly P2, only one P1) WHAT A DISAPPOINT! (gd for pts not gd for me)
- unstable angina (tt's the P1 case, put her in resus rm, cardiac monitoring, pulse oximetry, ckmb, tropT... ECG.. doc took a look at the ECG, then called cardiologist, then nothing liao...
- woman with a junctional tachycardia and supposed thyrotoxicosis... but appeared with normal ecg today... under obs then d/c.
- quite severely anaemic man, now warded, i'm supposed to do a write up on him, got ESM at LSE (I MISSED! aaaaaaaRRRRGGGGGHHH!) *bang my head on the wall*
- old lady with a closed # of great trochanter of femur, warded too, maybe i'll write up on her (her # was relatively ez to spot BUT i couldn't spot the trabeculae displacments and mal-alignment, and that was impt, cuz that is the evidence of #... if it's occult #, go do MRI)
- lady with atrial flutter with transient block also warded, must go chk her cardiac enzymes tomorrow
- guy with bad bad headache, that's when i got quizzed about the 5 dx for headache, at the end of which, i was suffering from a low-grade tension headache too!
- guy with sudden swelling of wrist and elbow joint, and that's where the most severe bashing of the day took. bbbs... apparently, my ortho knowledge is damn lacking. sigh. i feel so stupid!
- a guy with 'down and out' left pupil - CN III palsy
- now this one's corny, this ENT personnel, apparently too bz of sth, decided not to see a pt with blocked ear (cannot hear well) cuz of earwax! lolz... it's pretty funny to see a doc irrigating someone's ear in the A&E area for P2 pts. LOLZ... and have the pt walk out in the pink of health. nb: usually they dun irrigate like that, cuz if it's an impacted earwax, can cuz bleeding (quote ojj), they use this (i cannot rem what) to soften the ear wax, takes abt 2 wks.
- saw x ray of chronic diaphrammatic hernia (bewtiful) + apical patchy opacities (could be TB)
- saw a lot of ECGS... bah, real life ECGS are like so ugly... saw SVT, VT, AFl, and peaked T waves... impt manz... peaked T wave seen in RENAL patients who default on dialysis... why? coz HYPERKALAEMIA! this is v v impt, cuz if u miss, the pt can go into all other kinds of cardiac disarhythmias and then it'll be hard to get him out of it, and even if u did, if u don't treat the underlying cause, u're probably gonna lose the guy!
oooh, the interesting one...
a man came in, cannot close his mouth, cannot bare his teeth, complains of weakness in lower limbs, slurred speech. one hosp's A&E had diagnosed him as having had a 'mild stroke' (sounded like 'mal sook' when the man tried to tell us)
the master of antidotes decided it was actually a TMJ dislocation, and ya, i got to feel the gap there too. and later learnt to read the xray. unfortunately, i missed the reduction! he had to do it when i was away at lunch lor... wasted. (Ps tt goes to say, the reduction was done under 20min!)
i'm so tired, i collapsed into the taxi and woke up close to home.
the docs and nurses mostly agree that the doc with the big nose is a bit kiasu, go cast my leg for a sprain... i think splinting would be enuff... or at least a half cast... the docs offered to saw it for me if i wanted to. heh i shall think abt it. :) i want to have a hand in sawing too!
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francesca chiu
2 eyebags & 5 wrinkles
on long-term dormicum drip
KIV IMH
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