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In any other rotation, I would have finished last Friday. But not this rotation. This rotation is 12 weeks long. Therefore I have to tolerate this rotation another 2 weeks.
Give me patience.
Give me patience.
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So I come back to rehab after my ALS course (did I mention we both passed? :-D) and I find out that one of my patients destabilised over the weekend. I knew this because she had had bloods taken on Sunday. I asked my registrar, "What happened to Mrs. X?"
"Oh yeah, she was febrile on the weekend and she has a Pseudomonas UTI," came the reply.
"Oh dear. So what antibiotics have we got her on?"
"Ceftriaxone. We are waiting for the sensitivities."
...
...
My OS, "Haha, I'm going to go out on a limb and say it WON'T be sensitive. That's the funny thing about Pseudomonas...it is never sensitive to ceftriaxone."
Anyway, sure enough, no ceftriaxone sensitivities and only intermediate sensitivity to Timentin even. In the end I changed her to ceftazidime; hope she's better by tomorrow but it's no surprise she has been spiking fevers for the past two days T.T
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MET call today in the psychogeri ward. Patient febrile; septic. 18G IV access, drew 20 mL of blood.
"Quick, give me a red top,, purple top and blood culture bottles"
Silence...
Then I get handed the blood tubes but...no blood culture bottles.
"Um...no culture bottles?"
Response from the intern, "这里很参的啦，什么都没有."
OK...no blood culture bottles, even on the crash cart? WTF?? T_T
"Quick, give me a red top,, purple top and blood culture bottles"
Silence...
Then I get handed the blood tubes but...no blood culture bottles.
"Um...no culture bottles?"
Response from the intern, "这里很参的啦，什么都没有."
OK...no blood culture bottles, even on the crash cart? WTF?? T_T
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Today I attended a MET call for one of the other teams' patients. This gentleman was in the middle of physiotherapy when he collapsed on the floor with witnessed headstrike but no LOC. On initial assessment he was slightly altered with slight disorientation, maintaining his airway, good sats, tachycardic at 130 and hypertensive at 200 systolic. His background is right basal ganglia haemorrhage resulting in left hemiparesis and dysarthria.
ECG showed sinus tachy with no obvious cardiac ischaemia. Here's the fun bit. Put in an 18G cannula for him and took some blood then I ask the nurse to hang a bag of saline for him. One: there's no IV chart on the crash trolley which there should be given rehab patients never have existing fluid orders. Two: a person at the MET call who shall remain unidentified and unclassified asked me "Why are we giving fluids to this guy?"
Excuse me, I know we are in rehab but surely giving fluids to a collapse patient with tachycardia is standard treatment even if he is not hypotensive. No? What did everyone think? Fluids whilst we wait for ambos? Or sit on the tachycardic patient?
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Reading the first year med student OSCE I have realised the main difference between being a student and being a doctor. Still remember learning the basics of taking a history? The acronym WWQQAA and using the biopsychosocial model when questioning patients about their problems? As my partner so correctly puts it, 'as a med student, your job is to know the medical cause of the presenting complaint. Your history is focused on ruling in or ruling out differential diagnoses.' Do they have signs of chronic liver disease? What about symptoms of obstructive sleep apnoea? The psychosocial bit just gets swept under the rug.
As a doctor, you learn that the most important questions to ask are actually about the social side of the patient. Who lives with you? Do you care for anyone? How are your finances? Is there anyone that can help you with your partner? This is all because you quickly realise that our profession is all about discharging patients. How can we safely send this patient home? Importantly, how can we send them home safely QUICKLY. What are the things that will get in the way? What can we do about these things?
Who cares that the patient has signs of chronic liver disease? Gastromed will pick it up. I care more about the fact that you have a bed bound husband at home who you aren't coping with. Why? Because we can send you home with chronic liver disease but we can't send you home to a disabled husband. Social work ++++ thanks
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Found this little spot thanks to our Gen Med dinner on Thursday. It's tucked away in a back alley behind Dan Murphy's so honestly, a pretty bad location but anyway. This cafe scores a GCS of T3,M4,F4 resulting in a grand total of 11 which is a pretty good effort.
Their eggs benedict below is also very nice especially their smoked ham but their mushrooms are sour and I'm not sure if it's intentional. Overall, a nice place to relax on a Saturday morning!
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During the 2012 flu season, Southern Health provided unrestricted access to oseltamivir to attending patients, aiming to minimize and prevent outbreaks of influenza in the community. During this period, in excess of 500 courses were supplied to our patients. From the 8 of October oseltamivir (Tamiflu ) will be restricted again to high risk patients. Use of oseltamivir needs to be approved by Infectious Diseases unless there is positive testing for influenza.Of which 400 courses were probably in AAU. Go team!!! XD
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I just drove into the city to South Wharf DFO. Longest drive of my life. Some idiot decided it was a good idea to seal all major roads around the city south and east for a marathon event so the only remaining routes are Alexandra avenue and St. Kilda Rd. They may as well tell people, "Nope, we don't want your business in the city, fuck off and go home."
First class idiots T.T
First class idiots T.T
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I'm going to be introducing the GCS; Good Coffee Score
This cafe scores a GCS of 8
T1,M4,F3 Temp, Milk, Flavour
Unfortunately, just like the real GCS, a score of 8 means this cafe fails in its coffee and I wouldn't recommend it. That's all! About to try their food so hopefully they can do better...although they've already failed their first stage and they don't have any muesli.
Addit, it actually looks quite nice. Bon appetit!!
This cafe scores a GCS of 8
T1,M4,F3 Temp, Milk, Flavour
Unfortunately, just like the real GCS, a score of 8 means this cafe fails in its coffee and I wouldn't recommend it. That's all! About to try their food so hopefully they can do better...although they've already failed their first stage and they don't have any muesli.
Addit, it actually looks quite nice. Bon appetit!!
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Last night was just full of surprises from ED. After seeing the NSTEMI patient, we were referred this patient.
She's a 70 year old lady from HLC NH (Are we seeing a trend here guys? Are we??). Her relevant history is she's bed bound and requires full hoist transfer due to multiple sclerosis but is apparently cognitively quite well. She has had a productive cough for the past 24 hours and was found this morning unrousable and with a temperature of 32.2 degrees. On admission to ED, she was hypoxic, hypoglycaemic and hyperkalaemic.
Please note that at this point, I asked my registrar, "Is this patient palliative?" The reply?
"No, not at the moment. ED has already discussed with the family and they've made her NFR and not for ICU but the family want to trial medical management for now and re-discuss tomorrow".
"OK, so what's her renal function and pH?"
"Well, I can't remember what the exact pH was but the ED consultant said she was a bit acidotic and her renal function isn't actually that bad."
OK, fair enough. Since my registrar was busy admitting another patient, I went over to say hi to our next customer. Let me just say, when I walked in my first impression of the patient was not good. She had the classic "O sign", was tachypnoeic at at least 35 resps per minute, her sats were 89% on 15L via non-rebreather, she was tachycardic and hypotensive. She did not look well at all. In front of me lay her sequential VBGs. A quick glance at her latest VBG was worrying to say the least. Her pH was 7.069 and her lactate was 10. Ohhhh...kay... Really? Really??? We're going to treat this lady for one night to see how she goes?
So I spoke to the ED consultant. "Look, I'm just about to do the admission paperwork for this lady but can I just ask where are we going with her? I'll have to talk to my registrar but have you talked to the patient's family about palliating the patient tonight?"
"Yeah, we're just waiting for the other daughter to come in, she's the power of attorney."
Cool, so as long as the patient's in ED and my registrar's busy, I guess it's the ED's job to have these discussions with the family. Guess I won't interfere. In my admission notes: "Needs review by medical registrar later. As per discussion with ED consultant, patient likely for palliation given severity of sepsis and refractory nature of hypoxia, hyperkalaemia and hypoglycaemia. ED will discuss with patient's family when POA arrives."
Just then, a MET call was made upstairs. We went upstairs, fixed the patient and came back down to ED half an hour later. Patient had died already. She didn't even make it out of ED.
Should this patient have been referred in the first place? From the get-go, I feel this patient should have been palliated given her pre-morbid level of function and how severe her sepsis was. My kind-hearted partner argues that if you were in ED's position, you have to refer the patient at least for palliative measures. Who knows how long the patient will hang on for? You can't have a patient like this sitting in ED overnight. My argument is even without the power of attorney, ED should just have discussed with next of kin and palliated the patient after she failed to respond to the first round of treatment. Then the patient would have died before we could even see her and she would have been more comfortable in the end.
She's a 70 year old lady from HLC NH (Are we seeing a trend here guys? Are we??). Her relevant history is she's bed bound and requires full hoist transfer due to multiple sclerosis but is apparently cognitively quite well. She has had a productive cough for the past 24 hours and was found this morning unrousable and with a temperature of 32.2 degrees. On admission to ED, she was hypoxic, hypoglycaemic and hyperkalaemic.
Please note that at this point, I asked my registrar, "Is this patient palliative?" The reply?
"No, not at the moment. ED has already discussed with the family and they've made her NFR and not for ICU but the family want to trial medical management for now and re-discuss tomorrow".
"OK, so what's her renal function and pH?"
"Well, I can't remember what the exact pH was but the ED consultant said she was a bit acidotic and her renal function isn't actually that bad."
OK, fair enough. Since my registrar was busy admitting another patient, I went over to say hi to our next customer. Let me just say, when I walked in my first impression of the patient was not good. She had the classic "O sign", was tachypnoeic at at least 35 resps per minute, her sats were 89% on 15L via non-rebreather, she was tachycardic and hypotensive. She did not look well at all. In front of me lay her sequential VBGs. A quick glance at her latest VBG was worrying to say the least. Her pH was 7.069 and her lactate was 10. Ohhhh...kay... Really? Really??? We're going to treat this lady for one night to see how she goes?
So I spoke to the ED consultant. "Look, I'm just about to do the admission paperwork for this lady but can I just ask where are we going with her? I'll have to talk to my registrar but have you talked to the patient's family about palliating the patient tonight?"
"Yeah, we're just waiting for the other daughter to come in, she's the power of attorney."
Cool, so as long as the patient's in ED and my registrar's busy, I guess it's the ED's job to have these discussions with the family. Guess I won't interfere. In my admission notes: "Needs review by medical registrar later. As per discussion with ED consultant, patient likely for palliation given severity of sepsis and refractory nature of hypoxia, hyperkalaemia and hypoglycaemia. ED will discuss with patient's family when POA arrives."
Just then, a MET call was made upstairs. We went upstairs, fixed the patient and came back down to ED half an hour later. Patient had died already. She didn't even make it out of ED.
Should this patient have been referred in the first place? From the get-go, I feel this patient should have been palliated given her pre-morbid level of function and how severe her sepsis was. My kind-hearted partner argues that if you were in ED's position, you have to refer the patient at least for palliative measures. Who knows how long the patient will hang on for? You can't have a patient like this sitting in ED overnight. My argument is even without the power of attorney, ED should just have discussed with next of kin and palliated the patient after she failed to respond to the first round of treatment. Then the patient would have died before we could even see her and she would have been more comfortable in the end.
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What is the job of a medical registrar? Is it to admit patients? Is it to run a MET call? Is it to teach their interns and medical students? Is it to manage patients on the ward whilst the consultant is away? The answer is all of the above but I believe the job description in between the lines is to make sure ED don't miss any important diagnosis.
Because we are just so superior compared to our diagnostically challenged colleagues in ED *sarcastic smirk* Most of the time this isn't such an issue and ED are usually quite good at picking up the life threatening diagnoses so actually the medical registrar doesn't get to shine...just repeat the history and exam and chart up the medications until next morning. Yesterday was a different case for one of the patients I admitted though.
The patient in question was a 62 year old NESB Romanian gentleman who was referred for query urosepsis. He's from HLC NH, has an ABI from previous gunshot injury and a L) hemiplegia from a previous CVA; also HTN, hyperchol, IDDM. Initially presented with chest pain and was found to be febrile on admission. So ED found protein and leucs in his urine and started gent and amp. Fine. Sounds simple until you have a look at his ECG. ST depression in V1-2 and T-wave inversion in V4-6 on his admission ECG. OK.... The plot thickens when I call the nursing home for more collateral history (hey, isn't that ED's job as initial contact?). Patient complained of chest pain at 10am and was found to be pale and sweaty so the ambulance was called. Speaking to the patient with a phone interpretor yielded a similarly worrying history; sudden onset of central chest pain radiating down to his left arm, has had intermittent episodes of chest pain in the past 10 months with increasing frequency but has recently gotten better because...? Because he's recently changed from mobilising with 4WF to being wheelchair bound. (T_T)
So we add on a retrospective troponin to his bloods earlier on in the day. Surprise surprise...troponin of 8.98! Guess what folks? This patient with query urosepsis also has an NSTEMI...thank god he's now pain free. Talking to the cardiology registrar, the first sentence out of his mouth was, "Oh shit, how did this guy get referred to you guys? We'll take him."
Hurrah for ED diagnostic supremacy!
Because we are just so superior compared to our diagnostically challenged colleagues in ED *sarcastic smirk* Most of the time this isn't such an issue and ED are usually quite good at picking up the life threatening diagnoses so actually the medical registrar doesn't get to shine...just repeat the history and exam and chart up the medications until next morning. Yesterday was a different case for one of the patients I admitted though.
The patient in question was a 62 year old NESB Romanian gentleman who was referred for query urosepsis. He's from HLC NH, has an ABI from previous gunshot injury and a L) hemiplegia from a previous CVA; also HTN, hyperchol, IDDM. Initially presented with chest pain and was found to be febrile on admission. So ED found protein and leucs in his urine and started gent and amp. Fine. Sounds simple until you have a look at his ECG. ST depression in V1-2 and T-wave inversion in V4-6 on his admission ECG. OK.... The plot thickens when I call the nursing home for more collateral history (hey, isn't that ED's job as initial contact?). Patient complained of chest pain at 10am and was found to be pale and sweaty so the ambulance was called. Speaking to the patient with a phone interpretor yielded a similarly worrying history; sudden onset of central chest pain radiating down to his left arm, has had intermittent episodes of chest pain in the past 10 months with increasing frequency but has recently gotten better because...? Because he's recently changed from mobilising with 4WF to being wheelchair bound. (T_T)
So we add on a retrospective troponin to his bloods earlier on in the day. Surprise surprise...troponin of 8.98! Guess what folks? This patient with query urosepsis also has an NSTEMI...thank god he's now pain free. Talking to the cardiology registrar, the first sentence out of his mouth was, "Oh shit, how did this guy get referred to you guys? We'll take him."
Hurrah for ED diagnostic supremacy!
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Yesterday I walked into my cover shift, said hi to the nurses in AAU. First thing out of their mouths?
"Daniel! Did you know the man you admitted last night died?"
"What? Who is this?"
"Mr. X, with the humerus fracture?"
Turns out this gentleman was found blue and dead in his cubicle at 6am. Coroner's case.
I don't know... When I admitted him, he looked really well from the end of the bed. He had come in with a fall and subsequent humerus fracture on a background of long term postural hypotension being investigated by cardiology. Had some dizziness but not something out of the ordinary for him. No symptoms to suggest he had had a cardiac or neurological event.
Well, I'll find out if the coroner calls me soon...jiak lat T.T
"Daniel! Did you know the man you admitted last night died?"
"What? Who is this?"
"Mr. X, with the humerus fracture?"
Turns out this gentleman was found blue and dead in his cubicle at 6am. Coroner's case.
I don't know... When I admitted him, he looked really well from the end of the bed. He had come in with a fall and subsequent humerus fracture on a background of long term postural hypotension being investigated by cardiology. Had some dizziness but not something out of the ordinary for him. No symptoms to suggest he had had a cardiac or neurological event.
Well, I'll find out if the coroner calls me soon...jiak lat T.T
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Tada! Last cover tomorrow. I pray that it will be a quiet shift. I pray that all the patients will remain stable. I pray that Latrobe will be kind to me.
On the other hand, I really feel sorry for my co-intern. Her team is starting three days of being on take...with an existing patient load of 20 patients. Which means she will have 35 patients next Monday. So glad that's not me T_T
On the other hand, I really feel sorry for my co-intern. Her team is starting three days of being on take...with an existing patient load of 20 patients. Which means she will have 35 patients next Monday. So glad that's not me T_T
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Canon cameras may cause allergic reactions
Have a read of this article everyone! First time I'm so glad that I own a Sony =P
Have a read of this article everyone! First time I'm so glad that I own a Sony =P
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So, it's August already. For us, it signifies that the due date for PGY2 jobs is just around the corner, that our tax returns should be done ASAP if we want to claim any money back from the government, and unbelievably, we've been interns for 7 months.
7 months! Unbelievable when you think about it because it just seems like yesterday when we were still struggling to apply for internship and then arriving on the ward without a single clue about what we were doing (at least I was clueless anyway). Now, I'm managing ward calls, looking after patients with STEMIs, turfing patients to other teams, doing discharge summaries that make sense and all in all functioning as a pretty good doctor. Who would have known?
Another week and a half until I leave Traralgon. I think it's going to be a disaster leaving Traralgon for Dandenong AAU but I guess I have no choice but to move on. That said, it will be nicer to be back in the 'city'.
OK, enough procrastinating. Back to my cover letter...
7 months! Unbelievable when you think about it because it just seems like yesterday when we were still struggling to apply for internship and then arriving on the ward without a single clue about what we were doing (at least I was clueless anyway). Now, I'm managing ward calls, looking after patients with STEMIs, turfing patients to other teams, doing discharge summaries that make sense and all in all functioning as a pretty good doctor. Who would have known?
Another week and a half until I leave Traralgon. I think it's going to be a disaster leaving Traralgon for Dandenong AAU but I guess I have no choice but to move on. That said, it will be nicer to be back in the 'city'.
OK, enough procrastinating. Back to my cover letter...
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So many patients
So little time
So many pages
Why is my team the one on take Monday after being on take Friday, Saturday and Sunday? WHY?
I think I'm just dying slowly on the inside...bit by bit, because of this job.
On the bright side, I've coined a new syndrome: Latrobe Regional Syndrome
Everyone who comes into the hospital has the following issues:
1. CCF
2. Morbidly obese
3. COPD and still active smoker
4. Social issues that prevent them from going home
5. Undiagnosed cancer that are picked up on routine admission bloods
Any 4 of the above constitutes LRS and the prognosis of this condition is either they stay in a bloody long time or they get palliated and die this admission.
So little time
So many pages
Why is my team the one on take Monday after being on take Friday, Saturday and Sunday? WHY?
I think I'm just dying slowly on the inside...bit by bit, because of this job.
On the bright side, I've coined a new syndrome: Latrobe Regional Syndrome
Everyone who comes into the hospital has the following issues:
1. CCF
2. Morbidly obese
3. COPD and still active smoker
4. Social issues that prevent them from going home
5. Undiagnosed cancer that are picked up on routine admission bloods
Any 4 of the above constitutes LRS and the prognosis of this condition is either they stay in a bloody long time or they get palliated and die this admission.
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Same nurse as last night.
I have an obese patient, 190kg, admitted with CCF. We are diuresing him with 80mg IV frusemide QID. At around 11am, I received a page, "Please r/v Mr X, put in IDC? Pt tired and going to toilet +++." I showed the page to my registrar and said, "Should I just call back and say no? Or do you want me to go see the patient first?" The reply was simple, "Just say no."
I decided I may as well go and tell the nurse how stupid she was face to face. But then the stupid bitch wouldn't give up. "The patient is really tired and if he's going to toilet all the time and he can't sleep tonight, his condition will deteriorate." What was going through my mind at the time? "Yes, I know that making him wee all the time is going to be difficult because he has to get up and walk but he's got CCF and he's morbidly obese...we WANT him to walk more! Why would you want to put in an IDC and introduce another source of infection so that the patient can just sit around on his fat arse?"
I calmly explained to the nurse and the patient our rational for not putting in an IDC. Then when I was just about to leave, the nurse says, "Well, at least would you consider a frusemide infusion so that he can get continued effect from the frusemide?" T__T
Honestly, why would you ask such a stupid question? The only reason you would want frusemide is if you have to frequently titrate the dose for the patient's urine output if they are in renal failure. Why would you want to hook the patient up to another line so that the patient can have an excuse to lie in bed? WE JUST WANT HIM TO WEE LOTS! THAT'S THE POINT! Stop asking me for all these unnecessary treatments! Stop trying to think up things for me to do you stupid !@$#$! Stop trying to be clever! GRRRRR
I have an obese patient, 190kg, admitted with CCF. We are diuresing him with 80mg IV frusemide QID. At around 11am, I received a page, "Please r/v Mr X, put in IDC? Pt tired and going to toilet +++." I showed the page to my registrar and said, "Should I just call back and say no? Or do you want me to go see the patient first?" The reply was simple, "Just say no."
I decided I may as well go and tell the nurse how stupid she was face to face. But then the stupid bitch wouldn't give up. "The patient is really tired and if he's going to toilet all the time and he can't sleep tonight, his condition will deteriorate." What was going through my mind at the time? "Yes, I know that making him wee all the time is going to be difficult because he has to get up and walk but he's got CCF and he's morbidly obese...we WANT him to walk more! Why would you want to put in an IDC and introduce another source of infection so that the patient can just sit around on his fat arse?"
I calmly explained to the nurse and the patient our rational for not putting in an IDC. Then when I was just about to leave, the nurse says, "Well, at least would you consider a frusemide infusion so that he can get continued effect from the frusemide?" T__T
Honestly, why would you ask such a stupid question? The only reason you would want frusemide is if you have to frequently titrate the dose for the patient's urine output if they are in renal failure. Why would you want to hook the patient up to another line so that the patient can have an excuse to lie in bed? WE JUST WANT HIM TO WEE LOTS! THAT'S THE POINT! Stop asking me for all these unnecessary treatments! Stop trying to think up things for me to do you stupid !@$#$! Stop trying to be clever! GRRRRR
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Follow up from my post yesterday. May everyone learn from this and make sure you rewrite your medications instead of just crossing them off!!
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The thing that you don't want to hear just before you finish your shift are the words "MET Call". Tonight, I was paged at 9:45 about a patient's bradycardia. The page read "Pt bed 114 HR 42, please call X urgently r/v". I was attending a hypotensive patient so I ducked out to call the nurse.
"Hi, this is Daniel, Med cover"
"Oh hi, Daniel, can you come review Mrs X? She's got a heart rate of 42"
"OK. Is she symptomatic? How's her blood pressure?"
"She's not too bad, not really symptomatic. Her blood pressure is OK as well"
"Alright, if she's not symptomatic, can you give me 10 minutes? I'm just attending a hypotensive patient in the next ward"
"Alright, but come soon"
Not two minutes pass...
"MET call" "MET call" Grrrr....
So I walk over to the ward, walk in and said, "How is the patient?". The nurse replies, "Oh, she's a little short of breath." I look at the sats monitor: 99%. The patient is on nasal prongs. I thought to myself, "Really? Short of breath with perfectly normal sats? I don't think so. When I said symptomatic, I meant dizzy, drowsy, chest pain you idiot!"
Anyway, the MET team soon arrived. On evaluation of the drug chart and history, the patient came in with rapid AF in the setting of gastroenteritis. She was commenced on sotalol 20mg four days ago. Only problem? The home team had written 40mg initially and crossed it off, obviously changing their mind because she was an old lady. Unfortunately, they hadn't entirely scribbled out the "40" and the upstroke of the 4 sill remained next to the 20mg written above it...soooo at a quick glance it looked like 120mg.
"Uhhh....how much sotalol did you give this patient tonight?"
"120mg"
"Are you sure it wasn't 20mg?"
"Yes, I'm sure. 20mg is only a quarter of a tablet and we don't give that small a dose"
Then I looked at the chart again. Underneath the dose, written in purple ink by the kind pharmacist was "=20mg = 1/4 of 80mg"
Honestly, you stupid bitch. Did it ever cross your mind that a doctor wouldn't cross out 40mg and write 120mg? Does it not seem a little weird to that little brain of yours that the doctors would triple her sotalol dose? And did you even fucking bother to read the drug chart properly and look at what the pharmacist wrote, particularly the bit about "1/4 of 80mg"? OK, so it's at least partially the doctor's fault for not crossing it out entirely and recharting the sotalol but for the past 4 days the nurses with brains seem to have gotten it right, why couldn't you???
FAIL
"Hi, this is Daniel, Med cover"
"Oh hi, Daniel, can you come review Mrs X? She's got a heart rate of 42"
"OK. Is she symptomatic? How's her blood pressure?"
"She's not too bad, not really symptomatic. Her blood pressure is OK as well"
"Alright, if she's not symptomatic, can you give me 10 minutes? I'm just attending a hypotensive patient in the next ward"
"Alright, but come soon"
Not two minutes pass...
"MET call" "MET call" Grrrr....
So I walk over to the ward, walk in and said, "How is the patient?". The nurse replies, "Oh, she's a little short of breath." I look at the sats monitor: 99%. The patient is on nasal prongs. I thought to myself, "Really? Short of breath with perfectly normal sats? I don't think so. When I said symptomatic, I meant dizzy, drowsy, chest pain you idiot!"
Anyway, the MET team soon arrived. On evaluation of the drug chart and history, the patient came in with rapid AF in the setting of gastroenteritis. She was commenced on sotalol 20mg four days ago. Only problem? The home team had written 40mg initially and crossed it off, obviously changing their mind because she was an old lady. Unfortunately, they hadn't entirely scribbled out the "40" and the upstroke of the 4 sill remained next to the 20mg written above it...soooo at a quick glance it looked like 120mg.
"Uhhh....how much sotalol did you give this patient tonight?"
"120mg"
"Are you sure it wasn't 20mg?"
"Yes, I'm sure. 20mg is only a quarter of a tablet and we don't give that small a dose"
Then I looked at the chart again. Underneath the dose, written in purple ink by the kind pharmacist was "=20mg = 1/4 of 80mg"
Honestly, you stupid bitch. Did it ever cross your mind that a doctor wouldn't cross out 40mg and write 120mg? Does it not seem a little weird to that little brain of yours that the doctors would triple her sotalol dose? And did you even fucking bother to read the drug chart properly and look at what the pharmacist wrote, particularly the bit about "1/4 of 80mg"? OK, so it's at least partially the doctor's fault for not crossing it out entirely and recharting the sotalol but for the past 4 days the nurses with brains seem to have gotten it right, why couldn't you???
FAIL
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Forget about your stethoscope or your tendon hammer. This is what a doctors life is all about, consumed with phone calls left, right and centre =)
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One of my patients who was admitted last night died just now. We don't know why. He was admitted for delirium and the last thing I did for him was give him some PRN olanzapine and oxazepam and put in an IDC for him. Now he's dead. We don't know why. He was well one minute, slightly low sats of 95% 5L and then two minutes later the nurses found him dead. Cardiac arrest? PE? Who knows? We will never know because he isn't a coroner's case and we won't be doing an autopsy.
Ah well, another one bites the dust and I have one less patient for tomorrow. May he rest in peace.
Ah well, another one bites the dust and I have one less patient for tomorrow. May he rest in peace.
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We should change our team name from "General Medicine" to "Surgical Dumping Ground". Because that's what we do!
Orthopaedic patients come in for hip replacements, develop acute renal failure and pneumonia because they can't be bothered looking after their patients. And then they say "no acute surgical issues, await rehab. Medical referral for acute renal failure". And then what? Take of care by medical team. Patient continues to deteriorate, goes into septic shock and dies a few days later. And you know what's the kicker? Because they've recently had an operation, they become a reportable death and the medical intern (i.e. me) ends up having to call the coroner's court and do all the fucking paperwork!
GARRRRR!!! X_X
Orthopaedic patients come in for hip replacements, develop acute renal failure and pneumonia because they can't be bothered looking after their patients. And then they say "no acute surgical issues, await rehab. Medical referral for acute renal failure". And then what? Take of care by medical team. Patient continues to deteriorate, goes into septic shock and dies a few days later. And you know what's the kicker? Because they've recently had an operation, they become a reportable death and the medical intern (i.e. me) ends up having to call the coroner's court and do all the fucking paperwork!
GARRRRR!!! X_X
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Today, one of the surgical patients was sitting on the ward; a new admission with pan ischaemic colitis, for conservative management and not for surgical intervention. In the ED notes, it was written that this patient had been reviewed by the surgical consultant and the decision was for "trial of palliative antibiotics".
Firstly, what the fuck is that meant to be? How does ceftriaxone and metronidazole help in ischaemic colitis. Secondly, if you're going to fucking use the term "palliative antibiotics" then at least you can have a discussion with the family and explain that the patient is probably going to die. The poor surgical intern was stuck on the ward with a dying patient who was in lots of pain, going into multi-organ failure (urine output 30mL in 24 hours despite 7 liters of fluid) and he couldn't palliate the damn patient because the consultant hadn't made that decision. On the NFR order, the patient was still for MET calls for Christ's sake!
The surgical registrar and consultant are, surprise surprise, scrubbed in theatre and wouldn't even answer the intern's calls. I am so unimpressed by what the surgical team is like at this hospital BUT I'm even less impressed with the ICU liaison nurse because the surgical registrar couldn't be fucked coming out of theatre so told the intern to call a MET call and get the medical team to sort things out. The MET call was made, the people arrived and what does the liaison nurse do first? Tell off the intern for "calling an inappropriate MET call" and saying this "is an inappropriate use of resources". What the hell??? First principle of a MET call? Don't blame anyone!!! Fucking tosser, honestly. And then the ICU team just buggered off and left us, the medical team to sort things out.
WTF...
Firstly, what the fuck is that meant to be? How does ceftriaxone and metronidazole help in ischaemic colitis. Secondly, if you're going to fucking use the term "palliative antibiotics" then at least you can have a discussion with the family and explain that the patient is probably going to die. The poor surgical intern was stuck on the ward with a dying patient who was in lots of pain, going into multi-organ failure (urine output 30mL in 24 hours despite 7 liters of fluid) and he couldn't palliate the damn patient because the consultant hadn't made that decision. On the NFR order, the patient was still for MET calls for Christ's sake!
The surgical registrar and consultant are, surprise surprise, scrubbed in theatre and wouldn't even answer the intern's calls. I am so unimpressed by what the surgical team is like at this hospital BUT I'm even less impressed with the ICU liaison nurse because the surgical registrar couldn't be fucked coming out of theatre so told the intern to call a MET call and get the medical team to sort things out. The MET call was made, the people arrived and what does the liaison nurse do first? Tell off the intern for "calling an inappropriate MET call" and saying this "is an inappropriate use of resources". What the hell??? First principle of a MET call? Don't blame anyone!!! Fucking tosser, honestly. And then the ICU team just buggered off and left us, the medical team to sort things out.
WTF...
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Just something I found today when I was on cover, look at what the surgeons wrote when they reviewed this patient in ED!! Unbelievable...this is what medicine has turned into, fighting to not take a patient.
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For the past three weeks, I've been spoiled. My consultant and registrar were both really chilled out and relaxed about patient treatment and there were discharges almost everyday. Seeing a patient was a 2 minute job. Patients were kicked out of hospital once they were even marginally stable before they could develop any complications. My new registrar, however, is very enthusiastic and knows all our patients in great detail. He's there at 5pm seeing our patients to check up on their progress for the day. He's making me call GPs to confirm patient's past medical history and why they are on certain medications. Worst of all? He does ward rounds in typical medical style; 30 minutes per patient where he explores all the patient's symptoms and updates all facets of their treatment.
*sigh* The remaining 7 weeks of this rotation is going to be long...
*sigh* The remaining 7 weeks of this rotation is going to be long...
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http://www.theage.com.au/victoria/census-reveals-citys-changes-20120624-20wme.html
Who says immigration isn't good for Australia? It may be slowly weeding out the Australian culture but personally, I think it's a good thing. Can't argue with the census statistics.
ONE in three of Melbourne's residents today was born in another country. Almost as many speak a foreign language at home. Nearly one in five is of Asian ancestry, mostly Chinese or Indian
First, Melbourne has become much better educated: the census found 72 per cent of adult residents have completed year 11 at least, compared to just 60 per cent in the rest of Australia
Second, Melbourne is relatively young.
Melbourne also has a higher rate of home ownership and, relative to housing prices, lower household debt.So basically what they're saying is immigration of Chinese and Indian people to Melbourne has made the city, in comparison to the rest of Australia, younger, better educated and richer...
Who says immigration isn't good for Australia? It may be slowly weeding out the Australian culture but personally, I think it's a good thing. Can't argue with the census statistics.
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Was on take yesterday, had a million new patients. As if I didn't have enough trouble and jobs to do today.
At 3pm, the HITH nurse calls me regarding two HITH patients. One patient's PICC line fell out during her sleep and she needed an urgent one put back in this afternoon. The other patient had swelling in the arm where his PICC was in. Guess what? He had a DVT! So he needed an urgent PICC line in the other arm and therapeutic clexane. Unbelievable...Million things to do and you dump these two new patients onto me (who by the way the HITH nurses threatened would have to be admitted to hospital under MY team if I couldn't get the PICC lines in! The nerve!!)
Anyway, luckily things worked out and the patients got their PICCs. Win =)
At 3pm, the HITH nurse calls me regarding two HITH patients. One patient's PICC line fell out during her sleep and she needed an urgent one put back in this afternoon. The other patient had swelling in the arm where his PICC was in. Guess what? He had a DVT! So he needed an urgent PICC line in the other arm and therapeutic clexane. Unbelievable...Million things to do and you dump these two new patients onto me (who by the way the HITH nurses threatened would have to be admitted to hospital under MY team if I couldn't get the PICC lines in! The nerve!!)
Anyway, luckily things worked out and the patients got their PICCs. Win =)
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Interesting article I read today from the Canadian Medical Association Journal titled "Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne" Basically summarized, the diagnoses one can draw from analysing the characters from Winnie the Pooh are:
1) Pooh - ADHD and OCD
2) Eeyore - depression or dysthymic disorder
3) Piglet - generalised anxiety disorder
4) Christopher Robinson - schizophrenia
5) Tigger - ADHD, hyperactivity-impulsivity disorder
6) Rabbit - OCD, narcissistic personality disorder
Not exactly prime children's reading material huh?
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This morning the temperature was -1 degrees Celsius. Apparently it was so cold that it broke the heating in the hospital so it was like working in a fridge all day. But that doesn't make any sense to me at all...why someone would design a heating system that fails when you need it the most. And then the other thing that doesn't make sense to me is why the hospital won't turn off the heating until it's fixed because basically what it was doing today was turbocharging cold air into the wards. You couldn't stand under a vent without your goosebumps coming up.
And apparently the rest of the week is going to be about the same as well.
And apparently the rest of the week is going to be about the same as well.
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My childhood...if I could find a nintendo or computer to play games
What the children of today play...all the time
Today I wandered around the hospital cafe and found three parents with their children eating lunch. The children were no more than 10 years old and each of them were holding an iPad playing games. It's a wonder when you think about how much games have advanced over the years such that even portable gaming is now more advanced than computer games back then.
But now this means that children of today are nowhere near as sociable or active as the children of yester-years. They all sit in their chairs holding their modern Apple devices swiping their fingers back and forth, oblivious to their surroundings. Honestly, the younger generation are just becoming vegetables nowadays...but at least they have good games to consume their time and brain cells.
Today I wandered around the hospital cafe and found three parents with their children eating lunch. The children were no more than 10 years old and each of them were holding an iPad playing games. It's a wonder when you think about how much games have advanced over the years such that even portable gaming is now more advanced than computer games back then.
But now this means that children of today are nowhere near as sociable or active as the children of yester-years. They all sit in their chairs holding their modern Apple devices swiping their fingers back and forth, oblivious to their surroundings. Honestly, the younger generation are just becoming vegetables nowadays...but at least they have good games to consume their time and brain cells.
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Was eating dinner with my registrars last night when an earthquake struck. Apparently the epicenter was 30km away from Traralgon, measured 5.2 on the Richter scale. The tremors lasted a full minute and the lights were swinging back and forward on the ceiling. One of my registrars was quite distressed by the fact that her soup was shaking in her bowl (even though she is from Indonesia, a place where earthquakes are quite common). Me? I just kept eating...haha. Am I too insensitive?
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Summary of events for today:
0745 Medical handover
0815 Start ward round
0835 Finished ward round, consultant arrives
0845 Finished consultant ward round, go for coffee
0915 Back on the ward, discharge scripts done for tomorrow's discharges
0920 My registrar announces that he will be taking his half day off unofficially and drive back to Melbourne to visit his wife
1200 Finished calling cardiologist, nephrologist and successfully sent a patient to his new nursing home
1230 Went for lunch
1300 Organised bloods for tomorrow, home
Pager is still on at the moment, praying that I won't get paged about the 5 patients I have on the ward =) Planning to go back at 1645 to handover nothing to the evening HMO.
However, my team is on take today so tomorrow will not be as pleasant.
0745 Medical handover
0815 Start ward round
0835 Finished ward round, consultant arrives
0845 Finished consultant ward round, go for coffee
0915 Back on the ward, discharge scripts done for tomorrow's discharges
0920 My registrar announces that he will be taking his half day off unofficially and drive back to Melbourne to visit his wife
1200 Finished calling cardiologist, nephrologist and successfully sent a patient to his new nursing home
1230 Went for lunch
1300 Organised bloods for tomorrow, home
Pager is still on at the moment, praying that I won't get paged about the 5 patients I have on the ward =) Planning to go back at 1645 to handover nothing to the evening HMO.
However, my team is on take today so tomorrow will not be as pleasant.
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Yesterday whilst drinking coffee with my consultant, my registrar asked if he could sign off his case presentation as a mini-CEX
Cons: Sure, no problem. That should be fine.
Reg: OK. Do you mind if I tell the other registrars? Because they presented cases to you as well.
Cons: Um, yeah. I don't mind. I'm sure Reg X would be more than happy for that but I'm not sure about the other one...she's struggling a bit.
Reg: Yes. But do you think she comes across as being a bit uncertain and lacking confidence?
Cons: No, she's struggling a bit. She misses things and this is from patients she admitted.
*silence*
And my fifth year and I just say there listening to the conversation. I mean, there are only three female registrars so I could guess who they are talking about. Awkward...
Cons: Sure, no problem. That should be fine.
Reg: OK. Do you mind if I tell the other registrars? Because they presented cases to you as well.
Cons: Um, yeah. I don't mind. I'm sure Reg X would be more than happy for that but I'm not sure about the other one...she's struggling a bit.
Reg: Yes. But do you think she comes across as being a bit uncertain and lacking confidence?
Cons: No, she's struggling a bit. She misses things and this is from patients she admitted.
*silence*
And my fifth year and I just say there listening to the conversation. I mean, there are only three female registrars so I could guess who they are talking about. Awkward...
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Ward rounds finished by 11am.
Registrar forcibly takes pager off me.
I do the bloods for the weekend, chart antibiotics for one of the patient.
Then I go home. Driving back from Traralgon in the sunshine...very nice =)
Registrar forcibly takes pager off me.
I do the bloods for the weekend, chart antibiotics for one of the patient.
Then I go home. Driving back from Traralgon in the sunshine...very nice =)
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My life is so boring without internet access. Today one of my housemates finally figured out how to connect to the wireless network available from theatre. Now I'm free to blog and free to browse the internet at high speeds. Yay to technology!!
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Second day in Traralgon. Wasn't impressed with my first day at work. Spent the whole evening trying to get my wireless working but failed. At the moment, relying on the super slow internet from my iPhone to check my email and blog.
Wonderful...
Wonderful...
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I'm sitting in my room in Traralgon. It's cold. It feels so lonely. I want to go home!
10 weeks of Gen Med, not looking forward to it at all. I'm sharing a house with 4 others but for some reason I feel anti-social and don't want to participate in any of the conversations.
Check in on me in another few weeks to make sure I haven't died yet. Perhaps I'm depressed. Maybe that's the problem and I should take some stress leave. Maybe I'm just lazy. Maybe I'm just totally over being an intern. Maybe...
10 weeks of Gen Med, not looking forward to it at all. I'm sharing a house with 4 others but for some reason I feel anti-social and don't want to participate in any of the conversations.
Check in on me in another few weeks to make sure I haven't died yet. Perhaps I'm depressed. Maybe that's the problem and I should take some stress leave. Maybe I'm just lazy. Maybe I'm just totally over being an intern. Maybe...
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One week in ICU has taught me a lot. Most important thing it
has shown me is the “other side of the fence”. For 9 weeks, I have spent all my
efforts in trying to sell my patients to ICU consultants so that they may have
HDU beds post-op. You pull out several excuses like “this patient has extensive
disease and will need a prolonged anaesthesia” or “this patient has severe IHD…but
has been asymptomatic since his CABG 3 years ago, BUT he has hypertension
>.>” What can I say? We interns exist to please our consultants and
registrars and so when they say “Daniel, book an ICU bed for this patient post
proctocolectomy”, I say, “Sure, I’ll go do it now.”
Throughout this week, I have seen colorectal patients come
through ICU post-op, some of which I remember making the referral for and
seeing in pre-admission clinic. I’ll be honest…none of them needed ICU.
However, back in my recent memories is a lady who died post-op from renal
failure because she didn’t have an ICU bed and couldn’t receive haemofiltration
in time after deteriorating on the ward. I can’t say that she would have
definitely survived if she had gone to ICU post-op but it is probable that she
would have had better vascular support than a couple of inexperienced interns
on the ward. What was supposed to be a simple elective surgery ended in tragedy
and who is to blame?
Of course we don’t play the blame game in medicine but it is
a fact that ICU rejected our referral for an ICU bed post-op. And it is a fact
that she was fluid overloaded by over-aggressive fluid resuscitation after the
first MET call but was not taken to ICU. And it is a fact that she was taken to
ICU the next day after we screamed for help…only for them to pour more fluid
into her, hit her kidneys with high doses of frusemide, and then turf her back
to the ward in the middle of the night. And it is a fact that after she
returned to the ward, the medical registrar we asked to see her thought she was
overloaded with a relatively normal BP and urine output so her fluids were
stopped to “dry her out”. And lastly it is also a fact that as her renal function
continued to deteriorate, there were no ICU beds and we weren’t confident
enough to give her the aggressive fluid resuscitation she needed…so she became
uraemic, narcotised, acidotic and died the next morning.
I don’t know…honestly…
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In the UK, there is a national policy that hospitals must adhere to; patients in the Emergency Department must be seen and admitted if necessary within 4 hours. This works in Great Britain because their Emergency Departments work as no more than triage stations. Patients are investigated and admitted under inpatient units whilst still receiving initial treatment. This means that physicians and surgeons have to stabilise their own patients in acute medical units that are separate to ED.
Let's turn our attention to Australia then, specifically at the health network I am working at now. We are now adopting a similar approach here with the "4 hour rule". You can see it boldly and proudly being advertised on our intranet site with the funky and catchy slogan "4 hours will be ours". The first problem is that our hospital hasn't adopted the same approach with stabilising patients as our UK counterparts. ED still holds the dual function of investigating and making the diagnosis then initiating treatment and stabilising the patient prior to referring to the appropriate inpatient unit. Then, if the inpatient unit is too slow to respond, ED reserves the right to ship the patient up to the hospital wards with a "Safe and Timely Care" which basically means if we write up the drug and fluids chart, the doctors on the ward can sort out the rest up there, give us our ED bed now.
I can tell you right now that this 4 hour rule isn't working for sick patients. Sure, simple cases of appendicitis or pneumonia, you can diagnose, treat and refer within four hours but for more complex resuscitation cases, 4 hours just doesn't cut it. Today, a patient came over from ED to ICU with respiratory arrest secondary to opioid narcosis. He had 1600mcg of naloxone, half as IM, half as IV so he was much better. Great news. So he was started on a naloxone infusion as per instructions of the ED toxicologist at a rate of 400mcg per hour. Simple? Let me give you some figures written in the ED nursing notes:
As per Dr. X instructions, naloxone infusion commenced at 400mcg/hour. Naloxone infusion made up with 2g naloxone in 500mL N/Saline commenced infusion at 1mL/hr = 400mcg/hour.
Anyone see a problem with the figures? YES! 1mL/hr is actually only 4mcg/hour so the patient was transferred from ED for 1 hour getting NO naloxone. Now, one might argue that this is a problem with the nurse and the nurse was too stupid to do a simple calculation but you can also make a fairly convincing case that the ED doctor should have reviewed the naloxone infusion AND if there wasn't the 4 hour rule, this would have been picked up earlier instead of the patient being in transit receiving a subtherapeutic dose of naloxone. Who knows? All I know is that if the government wants better care for hospital patients in EDs, putting time pressure on the doctors isn't the answer.
Let's turn our attention to Australia then, specifically at the health network I am working at now. We are now adopting a similar approach here with the "4 hour rule". You can see it boldly and proudly being advertised on our intranet site with the funky and catchy slogan "4 hours will be ours". The first problem is that our hospital hasn't adopted the same approach with stabilising patients as our UK counterparts. ED still holds the dual function of investigating and making the diagnosis then initiating treatment and stabilising the patient prior to referring to the appropriate inpatient unit. Then, if the inpatient unit is too slow to respond, ED reserves the right to ship the patient up to the hospital wards with a "Safe and Timely Care" which basically means if we write up the drug and fluids chart, the doctors on the ward can sort out the rest up there, give us our ED bed now.
I can tell you right now that this 4 hour rule isn't working for sick patients. Sure, simple cases of appendicitis or pneumonia, you can diagnose, treat and refer within four hours but for more complex resuscitation cases, 4 hours just doesn't cut it. Today, a patient came over from ED to ICU with respiratory arrest secondary to opioid narcosis. He had 1600mcg of naloxone, half as IM, half as IV so he was much better. Great news. So he was started on a naloxone infusion as per instructions of the ED toxicologist at a rate of 400mcg per hour. Simple? Let me give you some figures written in the ED nursing notes:
As per Dr. X instructions, naloxone infusion commenced at 400mcg/hour. Naloxone infusion made up with 2g naloxone in 500mL N/Saline commenced infusion at 1mL/hr = 400mcg/hour.
Anyone see a problem with the figures? YES! 1mL/hr is actually only 4mcg/hour so the patient was transferred from ED for 1 hour getting NO naloxone. Now, one might argue that this is a problem with the nurse and the nurse was too stupid to do a simple calculation but you can also make a fairly convincing case that the ED doctor should have reviewed the naloxone infusion AND if there wasn't the 4 hour rule, this would have been picked up earlier instead of the patient being in transit receiving a subtherapeutic dose of naloxone. Who knows? All I know is that if the government wants better care for hospital patients in EDs, putting time pressure on the doctors isn't the answer.
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This week is meant to be a nice week. It's my ICU week which
means I get to take a break from surgery 1 week earlier than the other surgical
interns. It's great because I can observe an practice all the procedures that
you won't see on the ward, colloquially known as “plumbing”. Basically any
patient that is sick enough to come into ICU requires haemodynamic monitoring
and access in the form of arterial lines, central lines and occasionally
vascaths.
Today I was standing from 11:30am to 5:30pm without sitting
down at all except for the brief 10 minutes I took for lunch at 4:30pm. The
reason? It was decided around midday that a patient would need a vascath put in
for haemodialysis (acute on chronic renal failure secondary to sepsis). But
because the patient was uraemic, we needed to intubate and sedate otherwise he
would have pulled out all his lines and bled everywhere. Anyway, so we
intubated him and kept him sedated with propofol. Then we got on to the “plumbing”.
First step was an arterial line. No left radial artery
because of CABG. So we went to the right. I put in the introducing needle, got
flashback, blood spurting out. Great. Tried to thread the guidewire. Wouldn’t
advance. What? So my registrar gloved up and tried to fix it. Refused to
advance. So my registrar concluded that it must have been some clot because he
had an arterial line pulled out three days ago in the same place. So my
registrar opened a new arterial pack and tried going more proximal. She got flashback,
threaded the guidewire in (with lots of difficulty but finally managed to get
it in) and then couldn’t get a BP reading. Not sure why but we had to try again
because an arterial line that can’t read the BP is like a plane that can’t fly.
Down to femoral. Ultrasound machine located the artery
beautifully. Only problem: the artery was sitting on top of the femoral vein. But
we were confident so we marked the artery and went for it again. Introducer
needle went in, blood came out, but it didn’t look like arterial blood. A blood
gas confirmed that it was in fact venous blood so we converted the “arterial
line” to a vascath. OK, fourth time lucky. Went to the other leg, found the
femoral pulse, needle went in, blood came out, looked pinker and it was more
pulsatile but because this was the fourth try, we took a blood gas to make sure
and guess what? It came back as venous blood. What the hell???
So we decided to convert it into a CVC. So I put the CVC
guidewire through the arterial line, took out the arterial catheter, threaded
the CVC on and took another gas. Came back as arterial this time. What??? T.T
Not sure what on earth was happening. I went through the same hole, so theoretically
we would be in the same vessel. So, we failed the CVC. By this time, it was
4:30pm and my registrar was starting to lose her will to live so we went to
have “lunch”. I left soon after (only rostered on until 4pm so not getting
paid) and they were still trying to get the arterial line and CVC in.
My goodness…just a terrible day for plumbing.
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After my second run of nights covering for surgical...I can finally say: I am finally free from the nightmare that is General Surgery!!! There is a saying that goes 'covering shift means you are covering for general surgery. Forget about colorectal, you're just the gen surg replacement'. Anyway, I'm done with west 3 and all the stupid pages about gen surg patients about issues that should have been sorted out during the day. Couple of things I encountered:
1) patient post op that didn't have any of her regular meds charted nor adequate analgesia (and the regular meds include amiodarone!)
2) IV cannula that didn't get done even though it had been tissued since midday
3) numerous transfers from Casey whom the gen surg registrars never know anything about (talk about communication problems)
4) patient eating metal spoons (yeah, schizooooo)
5) patient with constipation who refuses to take aperients but still refuses to leave hospital
Forget about reading the notes to find out the plans for the patient you have just been paged to see; it's never documented so better off to just call the registrar. Average pages for colorectal patients per night: 1. Average pages for gen surg patients: a million. It does get to the point where you feel that you look after the patient during the evening and THEY cover for you during the day. Disgusting...
1) patient post op that didn't have any of her regular meds charted nor adequate analgesia (and the regular meds include amiodarone!)
2) IV cannula that didn't get done even though it had been tissued since midday
3) numerous transfers from Casey whom the gen surg registrars never know anything about (talk about communication problems)
4) patient eating metal spoons (yeah, schizooooo)
5) patient with constipation who refuses to take aperients but still refuses to leave hospital
Forget about reading the notes to find out the plans for the patient you have just been paged to see; it's never documented so better off to just call the registrar. Average pages for colorectal patients per night: 1. Average pages for gen surg patients: a million. It does get to the point where you feel that you look after the patient during the evening and THEY cover for you during the day. Disgusting...
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Because we bought it for Paw and Sabei, we remembered that we now have two pillows!!! Thank you for the great gift guys!!!
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Arrived in the mail today. Our gift for a special couple who we haven't met for so long. Happy wedding Paw and Sabei!
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Last shift today.
By far the worst shift of the 6 weeks.
None of my patients had proper pathology.
One didn't respond to treatment and is still in the department waiting for an LP.
But I made everyone happy before
I left by bribing them with chocolates.
The world is real!!
Good bye ED, hello two weeks of annual leave, hello colorectal surgery T.T
By far the worst shift of the 6 weeks.
None of my patients had proper pathology.
One didn't respond to treatment and is still in the department waiting for an LP.
But I made everyone happy before
I left by bribing them with chocolates.
The world is real!!
Good bye ED, hello two weeks of annual leave, hello colorectal surgery T.T
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In general, the emergency department gets busy after everyone finishes work at 5:00pm. Then it gradually gets quieter until about 11:00pm when people finally decide, "Nope, I don't think I'll be able to sleep tonight...better go see a doctor". This is what happened at 10:30 last night.
1. A patient came in GCS 3 due to overdose of alcohol and probably zopiclone. She was sleeping nicely, maintaining her airway so I took my sweet time taking a collateral history from her husband.
2. At 10:50, I talked to my consultant about this last patient I picked up and she tells me, "Normally, I wouldn't intubate these sort of patients because they maintain their airways pretty good despite their GCS and they sleep and wake up in the morning fine. However, I don't think I want to leave a patient with a GCS of 3 overnight when there's only registrars around. If we tube her now before handover, they won't have to worry about her at all. So here's what we're going to do: we're going to scan her head and then we'll tube her before 11:15 when we do handover."
3. This was fine...only problem was I also had another chest pain patient who I was trying to discharge, just waiting for a second troponin. Anyway, because this lady was GCS 3, a doctor had to accompany her to CT. Guess who that was? So I put in a second drip for her, then we wheeled her over to CT, scanned her head and came back. Time: 11pm
4. Whilst the nurse was getting set up for intubation, I quickly ran back over to the main island, checked my other patient's bloods. Troponin negative. Excellent. Clinician complete, print discharge letter, walked over to short stay, confirmed patient still chest pain free, IV bung out, discharge.
5. Then ran back over to resus, just in time for pre-oxygenation. Registrar tubed my lady. Time: 11:15.
6. Handover started, but my consultant asked me to call Gen Med and ICU to let them know about this patient. So I go call them, tried to make it as short as possible. Back to handover by 11:20.
My goodness...busiest half an hour of my life T.T
1. A patient came in GCS 3 due to overdose of alcohol and probably zopiclone. She was sleeping nicely, maintaining her airway so I took my sweet time taking a collateral history from her husband.
2. At 10:50, I talked to my consultant about this last patient I picked up and she tells me, "Normally, I wouldn't intubate these sort of patients because they maintain their airways pretty good despite their GCS and they sleep and wake up in the morning fine. However, I don't think I want to leave a patient with a GCS of 3 overnight when there's only registrars around. If we tube her now before handover, they won't have to worry about her at all. So here's what we're going to do: we're going to scan her head and then we'll tube her before 11:15 when we do handover."
3. This was fine...only problem was I also had another chest pain patient who I was trying to discharge, just waiting for a second troponin. Anyway, because this lady was GCS 3, a doctor had to accompany her to CT. Guess who that was? So I put in a second drip for her, then we wheeled her over to CT, scanned her head and came back. Time: 11pm
4. Whilst the nurse was getting set up for intubation, I quickly ran back over to the main island, checked my other patient's bloods. Troponin negative. Excellent. Clinician complete, print discharge letter, walked over to short stay, confirmed patient still chest pain free, IV bung out, discharge.
5. Then ran back over to resus, just in time for pre-oxygenation. Registrar tubed my lady. Time: 11:15.
6. Handover started, but my consultant asked me to call Gen Med and ICU to let them know about this patient. So I go call them, tried to make it as short as possible. Back to handover by 11:20.
My goodness...busiest half an hour of my life T.T
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Gambate!!
Sick people, please stay home tonight...or go to Alfred hospital =)
Sick people, please stay home tonight...or go to Alfred hospital =)
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Just finished another batch of night shifts. Basically been a vampire for the past 2 weeks, working from 11pm to 9am for four nights in a row then couple of days off and then another 4 nights in a row. Good news: only one more night shift for the whole rotation left (this Sunday...haha). Bad news: most of the night shifts weren't too kind to me. Most nights I walk in the door and there are ten patients waiting to be seen with no free cubicles. Even on the few nights that are "quiet", I still work non stop basically without breaks because there's usually only two registrars, one HMO and little old me for the whole department. That said...things that happened in the past two weeks?
1. Successfully did my first LP. Unfortunate for the patient is that she had viral meningitis (but we knew that already, didn't we?? =P)
2. Saw a stroke registrar thrombolyse a patient...then got told off by the consultant she woke up and called in at 5am because the patient's symptoms actually didn't fit in with the CT findings (and of course the thrombolysis didn't help with the symptoms)
3. Heard a palliative care consultant swear over the phone when I referred him a patient (not at me...at the GP who stopped the poor patient's analgesia)
4. Had my first patient die. Patient came in with NSTEMI and arrested halfway through the night. We did CPR for well over one hour but couldn't save him
5. Nearly got kicked in the face by a psych patient coming in agitated from drugs
6. Saw a patient who crashed his go-kart at >80kph. Surprisingly he only suffered a comminuted fracture of his distal radius
Anyway, now I'm back to the normal life of a day doctor. Excellent!
1. Successfully did my first LP. Unfortunate for the patient is that she had viral meningitis (but we knew that already, didn't we?? =P)
2. Saw a stroke registrar thrombolyse a patient...then got told off by the consultant she woke up and called in at 5am because the patient's symptoms actually didn't fit in with the CT findings (and of course the thrombolysis didn't help with the symptoms)
3. Heard a palliative care consultant swear over the phone when I referred him a patient (not at me...at the GP who stopped the poor patient's analgesia)
4. Had my first patient die. Patient came in with NSTEMI and arrested halfway through the night. We did CPR for well over one hour but couldn't save him
5. Nearly got kicked in the face by a psych patient coming in agitated from drugs
6. Saw a patient who crashed his go-kart at >80kph. Surprisingly he only suffered a comminuted fracture of his distal radius
Anyway, now I'm back to the normal life of a day doctor. Excellent!
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