I apologise for not keeping this blog up to date, but Christmas and New Years are pretty good excuses for not spending time on the internet updating blogs.

I saw 5 patients today, which is a new record for me - a mere medical student. I am focussing on admitting patients and following them up until discharge from ED. I try and do some practical stuff if possible, but not much happened today in that regard.

My first patient was a middle aged guy who came in for a routine INR check. He has been diagnosed with thyrotoxicosis, and has rapid AF because of that therefore was put on warfarin on 14/12/2005. His INR on last check was 3.6. The range we need it to be is between 2 and 3. Anyhow, I took a routine bleeding history and assessed him thoroughly. An INR was sent off, but came back as invalid because the tube was filled incorrectly. I went back to take some more blood, and the patient had disappeared. Repeated calls to his house yielded only the answering machine. There was no sign of him for the rest of the day. My first patient who had walked out on me. Perhaps he thought since the test was done, that was all that is required. Out duty of care is to make sure we follow him up as best as possible. I made numerous calls to his house to no avail. He was gone for good.

My second patient came with central chest tightness radiating to her back, and left arm. A cardiac cause must be eliminated. Bloods were done, and ECG showed no signs of cardiac damage. She has a history of hiatus hernia, which put the possibility that reflux oesophagitis may be cause. I didn’t think of this, by the way. My supervisor did. She was later discharged with advice for her reflux, and possible endoscopy being done if her reflux persists. Her pain settled after taking some anginine tablets, and she did not require morphine - which was a good sign in the end.

My third patient was a young girl (24year old) who presents with abdominal pain, and watery diarrhoea. Her cousins have all been affected after eating out during Christmas, but her cousins have since recovered, except herself. History and examination was quite classic of a gastroenteritis picture. No investigations is necessary as most bouts of gastroenteritis resolve themselves. Antibiotics were not necessary. The patient was not vomiting, and her fluid balance was good. She was mildly dehydrated, and had lost some weight. She was discharged with advice to watch her diarrhoea, and eat and drink adequately. If her diarrhoea continues past 14 days, then a stool culture can be arranged through her GP.

My fourth patient was a young guy who was out partying with his friends, and was causing “trouble” to the general public. Anyhow he was going around the streets, kicking street signs and cars when he twisted his knee and lost balance. There was no history of trauma to the knee. Examination revealed a medial collateral ligament laxity, and an X ray revealed nothing abnormal (ruled out avulsion fractures). He was discharged with pain relief, and follow up with GP and he was welcome to come back if the pain persists, or worsens in the next 5 days. It was interesting how the patient tried to avoid the real story as how he got injured. He first started off by saying that this happened while kicking a football, then got into trouble by saying it happened at 1045pm at night. Kicking footballs on the field after 10pm was highly suspicious, and my look prompted to say: “Look, I will tell you what really happened”. He was also involved with the police that night.

My last patient for the day came after falling down from his skateboard, was not wearing his helmet. He fell on outstretched arms, and was only 13 years old. An X ray revealed an undisplaced greenstick fracture of the distal third of the radius, with no evidence of joint dislocation. A plaster cast was done by me, and he was discharged with plaster care advice, and fracture clinic follow up.

Thus ends my day. This week marks my last week of my elective. It certainly has been a very long year for me, as I haven’t really had a good break and final exams were a killer. It has been a great experience at Dandenong Hospital, and I really did learn a lot - especially practical skills. I also learnt how a hospital actually works, as often discussing cases in the comfort of tutorial rooms does not give any indication of what really happens, and how it happens.

Tomorrow is my last shift - the afternoon shift. I sure as will be trying to break my 5 patient record. Hehehe. See you then!