13/9/10

So starts day one of our emergency med posting. Today I saw:

1. This uncle with a suspected intracerebral bleed. Referred from SP with an ICB + secondary parotid tumour. So he's got this facial palsy that looks pretty chronic. Plus a stroke like presentation. Upgoing plantars unilaterally etc. MRI showed an active bleed but wait, do bleeds occur IN the ventricles?

2. This 11 yr old kid pushed the button to change the traffic lights and crossed without waiting for it to change. He was hit by a motorbike. Left side of the face badly lacerated with 2 open wounds seen. The ?plastic surgeons spent 2 intensive hours ONLY suturing up his face and cleaning up the debri. His 'sakit!s' still rings in my mind when they were trying to apply local anaes.

3. A lady with Down syndrome comes in due to an alleged fall, a scalp wound on the posterior aspect of the head. I really pitied her because it took a while for the MA to find a good vein. It took a few tries too. She couldn't really speak... or understand us, so I couldn't really get a good hx from her. But wait what is this- she can't walk.

4. This Indian uncle came in due to acute shortness of breath, his BP was 209/160 WHATT!?!? but clinically all he had was an 02 bag. Not even breathless. So when I talked to him I learned that he was dx'ed with DM 1 yr ago and is on combi OHA and subcut insulin. BUT THEN HOR he also has had 2 digital and one below knee amputations liao. So fast one? He asked me when was my exam, and i told him it wouldnt be until 2012 for my last last final one. Then he told me an unbelievable thing 'Hey, I'm usually one of your patients for the final exams lah!' hahahahah. Krs asked and he told us that usually he's put under nephro or opthal. Yay for Indian uncle! :)

5. Chinese lady who was admitted due to LoC. Provisional dx- symptomatic anemia. But I'm pretty sure she's having some bleeding somewhere. For once the term 'pallor of the palmar creases' could be used here. Her lower lids were damn white too. But she seems a little out of it lah, I mean it took the other 2 AGES to ask what CA did she have before and it wasnt until her relative arrived that we finally found out the tumour was -- - jeng jeng jeng. of the ovaries.

6. IVDU man comes in with LoC as well. Thin, emanciated with obvious temporal wasting... Heck his WHOLE body was wasting lah. The MO put in the CVP into the wrong vessel so they ended up using the femoral vein. When he pulled down his pants then we saw the highways. They were treating him for septic shock, (suspected mycotic aneurysm) so he also had to be catheterized. There was an... erm... foreign object embedded in his penis. 'Bereng'? The MA took alot of fun asking us med students about it. 'U sure tak tau apa ni?' ---  Entah. Bereng? Beads? Hmmm internet pun takde lah abang!

7. Elderly uncle comes in due to an alledged fall. Laceration wound right in the midline of the skull above his head. MA sutures him up. Everything's fine and dandy until he was suspected to have TB and has never had treatment. WHAT THE

8. Our hero for the day. 27 year old guy, tall and thin (well he wasnt really tall but he was dark. so kinda fulfilled the -dark and handsome part) :P comes in with 2 day hx of sob + pleuritic chest pain. Upon ex, a spontaneous pneumo was suspected. Wow his chest dam nicce to percuss lor. just tap a bit and it goes PONG! Anyways they did a chest drain on him and he's recovering well now. Nice uncomplicated hx and easy to follow up- i've got my emergency case down pat.

ps- today i saw a perforated eardrum as well as a normal one. The normal one was mine. ha ha. luckily no wax.