There was a certain particular point just now around 2345 hours that I suddenly realized how important it was to have a pair of good good shoes. By good i mean comfortable. Its amazing that the Medical students MA's SN's and HO's don't get varicose veins from all the standing. When i sat down just now after the hours and hours of standing.. i actually felt. old.
ANYWAYS
37 yo female lady comes in with acute shortness of breath. I find out that she has bone mets 2' to Br CA. and she's even had a mastectomy. At the age of 37! It must have been at least 1-2 years before her ca was dx'ed. all at the age of 37. According to her there is no fmhx. but i never got to ask more about her risk factors, because she was so worried she had lung mets. She kept wanting to meet the oncologist, she's just had a metal plate inserted into her femur for a pathological fracture, she was accompanied by her bro and uncle, she's not married, i wonder if she's ever had the chance to experience losing her virginity, she was really really pale, she has nice veins for cannulization, she has pretty eyebrows too aside from being pretty in general, She told me she lost alot of weight, and that the disease was a very morbid one, she .... is only 37.
Indian uncle comes in due to a fall from an acute giddy episode. Had a bypass 10 years ago and a hx of DM which he takes both OHA and subcut insulin. Memang got hx of IHD one lah, so this time he says he felt giddy - Malignant htn? But he says he's compliant?!?!?! A few hours, 2 tired relatives, 2 failed brannulas and a chest xray later, he's obviously feeling alot better and says that - actually my scrape on my knee was the only reason i came in lah. Nicely missing out the SOB part. lol i talked to his wife and she confirmed the SOB, she was like 'dei, u HAD sob ok' lol so cute.
Today it was probably field day for neuro. I even saw our senior Nigel there. There was an 18 yo kid with a (big!) EDH, but question- do lucid intervals last for a whole week!??! that's how long that's passed since his fall. The only thing he has is probably a fractured clavicle and bleeding into the sclera. Symptom wise he's been unable to tolerate loud noises and been having headaches that are non progressive. 18 yo kid with a motor lah, who flew superman style when he drove into a pothole.
Next to him was an uncle in his 50's who came in from an alleged MVA. He's alert and everything but ha ha here's the catch- he's so darn confused. If you didn't actually understand what he was saying you'd think that he's totally fine. Until you realize that he's answering 'depends on what they find' about 10 times to 12 questions. When Nigel asked him to remember 3 things - car, window, house (I cant rembr if it was window)... and then asked him to repeat it about 8 seconds, later he said 'car, brother'. Full stop. A few mins later i asked him a few other questions and i thought he was a little less confused when he was able to tell me he worked in penang and had no medical illnesses.... Untile I asked him if he knows where he was now and he goes Johor. MRI brain showed a small SDH.
The last bed in the yellow bay housed an auntie who had a long hx of htn and known to be non compliant. Earlier in the day she told her husband she had a bit of headache, and after passing motion she said it got worse. Next thing you know she's warded, unconscious and sweating profusely. Dx? Haemorrhage stroke. MRI brain showed Basal ganglia bleeding that drained into the ventricles but thankfully with no midline shift. Even when they wheeled her to the ICU her GCS was probably still <10.
78 year old chinese auntie came in feverish, unconscious, obviously cachexic with a BKA of the Left limb. Our very very nice MO who decided to gave us a teaching in the end used her as the bedside case. Okay so apparently from that first sentence itself we're already supposed to kinda guess what's the dx. Let me just tell you what was done; Resuscitation with NS improved her condition tremedously as she gained consciousness; CBD showed concentrated urine; Vitals monitored; Reflo done there was no hypo/hyper; ECG showed no ischaemic changes, blood Ix's taken- takes damn long to get back so don't know what yet; The last i saw her CXR hadn't come back yet. Talking to the relatives revealed that she just had a stroke 2 months ago and her BKA was done in May this year. Provisional dx? :D
Thin, cachexic, jail inmate comes in with acute SOB. Unable to finish a sentence, very obviously tachypnoiec. p02 was around 90 i think. Can't remember his vitals but anyways. Hx of IVDU and goodness knows what else that goes on behind prison walls. I was unable to clerk him fully, to even get more details on his presenting complain as he was in so bad shape but what we found out later was that it was a full blown TB attack. Every body wore masks after that for the rest of the night. haha.
Middle aged uncle comes in with R hypochondriac pain, feverish and jaundiced. Dx?
PS he's a walking biohazard, and i spilled his blood! DENG!!
*Thank goodness for H202*
In cubicle 3 there was this man who came in after he got stung by an ant. Black fire ant (at least that was what i got from his translation lah) there are black fire ants one meh? he came in to yellow zone sweaty, reddish and very very obviously distressed. We were all like omg omg omg where pain where pain where pain. Then he went 'behind, my back'. I was like what happened?` who bang you? or if it radiated anywhere kinda abdominal pain like. Then he went 'no nonono, ant bite'. For a while there i was stunned, lol. like ,what? then it finally hit me - anaphylaxis! The yellow zone was very busy at that time, i think that was also the arrival of all the unconscious ones, so somehow or rather his HO beckons me to wheel him to the green zone. Which, btw, was more or less in a chaos as well (that's an oxymoron because it's always in a chaos!) and he told me that (in a very direct translation) - the ant bit him and he lost his sight. Now everthing's black and he's finding it very uncomfortable both generally systemically and progressively getting harder to breath. As he sits in the green zone he asked me if it was possible for him to lie down somewhere - cus he was still on a wheelchair! I reallllly wanted to take him to a bed, take his vitals and insert a line cus i could see that he was getting redder and sweatier. but i couldn't. needed the doctor's consent first. haiz. So i kept watching him and finally lah this HO came over, took one look at him and went 'shit he's going into anaphylactic shock'. What happened afterwards was definitely one worthy of the ER scenes. This was the first time i saw Hartmann's being used. Im glad that at least he's stabilized now. his friend also very funny lah 'hey just an ant bite right? Just one injection then ok dy right? then he can go home already?' I could see the HO roll her eyes like dude, he's going into respiratory distress you think one injection can cure all ah?
and the misc's...
Teenager comes in with 2 sites of jelly fish sting with sand still found on her feet.
More of the usual trauma cases
Less of the kids today --- ie : less bawling
or maybe it was just because i was in the yellow zone majority of my time
There was also this auntie who wanted to introduce me to her husband's friends son who's a very nice guy cause i wheeled her to the toilet so she figured i must be just as nice. if not nicer :P
Everything else was more on the :| side. Not as funny as that one.
OH i also set my first 2 brannulas (FINALLY HALLELUJAH!) but i did fail like about 348274897256384 before that. My brannula's bleed.... alot. :(
The staff's were damn nice lah today!
and catheterized a lady as well.
I don't want to be a space occupying lesion.
Had a prep talk from Dr Jonathan. lol i didnt know the MRCS was useless.
*Day 4 has been left out consciously due to unforseen circumstances* :D
ANYWAYS
37 yo female lady comes in with acute shortness of breath. I find out that she has bone mets 2' to Br CA. and she's even had a mastectomy. At the age of 37! It must have been at least 1-2 years before her ca was dx'ed. all at the age of 37. According to her there is no fmhx. but i never got to ask more about her risk factors, because she was so worried she had lung mets. She kept wanting to meet the oncologist, she's just had a metal plate inserted into her femur for a pathological fracture, she was accompanied by her bro and uncle, she's not married, i wonder if she's ever had the chance to experience losing her virginity, she was really really pale, she has nice veins for cannulization, she has pretty eyebrows too aside from being pretty in general, She told me she lost alot of weight, and that the disease was a very morbid one, she .... is only 37.
Indian uncle comes in due to a fall from an acute giddy episode. Had a bypass 10 years ago and a hx of DM which he takes both OHA and subcut insulin. Memang got hx of IHD one lah, so this time he says he felt giddy - Malignant htn? But he says he's compliant?!?!?! A few hours, 2 tired relatives, 2 failed brannulas and a chest xray later, he's obviously feeling alot better and says that - actually my scrape on my knee was the only reason i came in lah. Nicely missing out the SOB part. lol i talked to his wife and she confirmed the SOB, she was like 'dei, u HAD sob ok' lol so cute.
Today it was probably field day for neuro. I even saw our senior Nigel there. There was an 18 yo kid with a (big!) EDH, but question- do lucid intervals last for a whole week!??! that's how long that's passed since his fall. The only thing he has is probably a fractured clavicle and bleeding into the sclera. Symptom wise he's been unable to tolerate loud noises and been having headaches that are non progressive. 18 yo kid with a motor lah, who flew superman style when he drove into a pothole.
Next to him was an uncle in his 50's who came in from an alleged MVA. He's alert and everything but ha ha here's the catch- he's so darn confused. If you didn't actually understand what he was saying you'd think that he's totally fine. Until you realize that he's answering 'depends on what they find' about 10 times to 12 questions. When Nigel asked him to remember 3 things - car, window, house (I cant rembr if it was window)... and then asked him to repeat it about 8 seconds, later he said 'car, brother'. Full stop. A few mins later i asked him a few other questions and i thought he was a little less confused when he was able to tell me he worked in penang and had no medical illnesses.... Untile I asked him if he knows where he was now and he goes Johor. MRI brain showed a small SDH.
The last bed in the yellow bay housed an auntie who had a long hx of htn and known to be non compliant. Earlier in the day she told her husband she had a bit of headache, and after passing motion she said it got worse. Next thing you know she's warded, unconscious and sweating profusely. Dx? Haemorrhage stroke. MRI brain showed Basal ganglia bleeding that drained into the ventricles but thankfully with no midline shift. Even when they wheeled her to the ICU her GCS was probably still <10.
78 year old chinese auntie came in feverish, unconscious, obviously cachexic with a BKA of the Left limb. Our very very nice MO who decided to gave us a teaching in the end used her as the bedside case. Okay so apparently from that first sentence itself we're already supposed to kinda guess what's the dx. Let me just tell you what was done; Resuscitation with NS improved her condition tremedously as she gained consciousness; CBD showed concentrated urine; Vitals monitored; Reflo done there was no hypo/hyper; ECG showed no ischaemic changes, blood Ix's taken- takes damn long to get back so don't know what yet; The last i saw her CXR hadn't come back yet. Talking to the relatives revealed that she just had a stroke 2 months ago and her BKA was done in May this year. Provisional dx? :D
Thin, cachexic, jail inmate comes in with acute SOB. Unable to finish a sentence, very obviously tachypnoiec. p02 was around 90 i think. Can't remember his vitals but anyways. Hx of IVDU and goodness knows what else that goes on behind prison walls. I was unable to clerk him fully, to even get more details on his presenting complain as he was in so bad shape but what we found out later was that it was a full blown TB attack. Every body wore masks after that for the rest of the night. haha.
Middle aged uncle comes in with R hypochondriac pain, feverish and jaundiced. Dx?
PS he's a walking biohazard, and i spilled his blood! DENG!!
*Thank goodness for H202*
In cubicle 3 there was this man who came in after he got stung by an ant. Black fire ant (at least that was what i got from his translation lah) there are black fire ants one meh? he came in to yellow zone sweaty, reddish and very very obviously distressed. We were all like omg omg omg where pain where pain where pain. Then he went 'behind, my back'. I was like what happened?` who bang you? or if it radiated anywhere kinda abdominal pain like. Then he went 'no nonono, ant bite'. For a while there i was stunned, lol. like ,what? then it finally hit me - anaphylaxis! The yellow zone was very busy at that time, i think that was also the arrival of all the unconscious ones, so somehow or rather his HO beckons me to wheel him to the green zone. Which, btw, was more or less in a chaos as well (that's an oxymoron because it's always in a chaos!) and he told me that (in a very direct translation) - the ant bit him and he lost his sight. Now everthing's black and he's finding it very uncomfortable both generally systemically and progressively getting harder to breath. As he sits in the green zone he asked me if it was possible for him to lie down somewhere - cus he was still on a wheelchair! I reallllly wanted to take him to a bed, take his vitals and insert a line cus i could see that he was getting redder and sweatier. but i couldn't. needed the doctor's consent first. haiz. So i kept watching him and finally lah this HO came over, took one look at him and went 'shit he's going into anaphylactic shock'. What happened afterwards was definitely one worthy of the ER scenes. This was the first time i saw Hartmann's being used. Im glad that at least he's stabilized now. his friend also very funny lah 'hey just an ant bite right? Just one injection then ok dy right? then he can go home already?' I could see the HO roll her eyes like dude, he's going into respiratory distress you think one injection can cure all ah?
and the misc's...
Teenager comes in with 2 sites of jelly fish sting with sand still found on her feet.
More of the usual trauma cases
Less of the kids today --- ie : less bawling
or maybe it was just because i was in the yellow zone majority of my time
There was also this auntie who wanted to introduce me to her husband's friends son who's a very nice guy cause i wheeled her to the toilet so she figured i must be just as nice. if not nicer :P
Everything else was more on the :| side. Not as funny as that one.
OH i also set my first 2 brannulas (FINALLY HALLELUJAH!) but i did fail like about 348274897256384 before that. My brannula's bleed.... alot. :(
The staff's were damn nice lah today!
and catheterized a lady as well.
I don't want to be a space occupying lesion.
Had a prep talk from Dr Jonathan. lol i didnt know the MRCS was useless.
*Day 4 has been left out consciously due to unforseen circumstances* :D
