Day 6 - The evening shift
I am not a morning person, so thought today would take on the evening 10 hour shift. It was fun for the most part.
Patients I saw included a musculoskeletal cause for a chest pain (where ECG was normal, and CXR proved negative for fractures), a young man who presented with moderate epigastric pain since AM which has progressively become worse (Ix done: FBC, UEC, LFT, lipase, BSL) - I don’t know the outcome for this patient because I handed it over at midnight to the night admitting officer and rushed home after a long day’s work, and a man who presented to DEM after “knocking” his knee which turned out to be soft tissue injury after an X ray proved negative for a fracture.
I also got to plaster cast two legs: the first one for a Salter Harris Type II fracture of the distal fibula with no displacement on a 13 year old boy, and the second one was for a 30% tear of the Achilles tendon. Casting is fun. I like to get my hands dirty. Hehehe.
A couple of interesting patients were a 35 year old man who presented with DKA, and an elderly obese gentleman who presented with severe cardiac failure, scrotal oedema, and gross oedema of the his lower limbs, and ascites. Litres of fluid were drained from him. You had to see it to believe it, his legs were as big as elephants legs. He was in respiratory distress, and struggling to breath even at bed rest.
Another young boy presented with febrile convulsions, and had another convulsion while in DEM. This is unusual in that febrile convulsions usually occur only once, that too at the rapid change in temperature initially during the course of an illness. He was treated with IM midozalam. Another option would be rectal diazepam (at home) or IV diazepam. Of course IM routes in young children was much more sensible, and easier to delivery medication through.
Still no suturing. Actually there was a 3 year old who presented with a deep cut to the insider of his lip. I passed on the opportunity because the cut went through to the muscle layer, so two layers of stitches were required. Another reason is young children’s lips can be screwed up big time if you do not suture it appropriately, and they will show the remnants of poor workmanship later on in life. I do not want to be the focus of conversation of poor workmanship. Lips are a medicolegal issue also in females. Hopefully I will get some practice today. I start my shift in 1.5 hours.
Better get ready.