Friday, 7 December 2012

Abdo Pain 1 – Where Bean Stresses About a Patient

The weekend before abdo pain 1 I was mightily stressing.  A patient I had seen in ED minors had come in with abdo pain and bleeding and they were a few weeks pregnant.  Obviously, high on my list of differentials were ectopic and miscarriage.  When the Doctor saw them, they didn’t ask any of their own questions, they just listened to me present in front of the patient.  The patient was due to have an early scan in 5 days and the Doctor decided they would be ok to discharge until then.  I was terrified I had missed a really important question to ask that would have made the doctor spot a red flag symptom I did not have the experience to notice yet.  I was even more terrified when I realised I was due to be in the early pregnancy unit for the patient’s scan.  I had nightmares of the scan showing she’d miscarried and then her yelling at me that it was all my fault because I hadn't admitted her then and there.  What was worse, was that the ED Dr said it was fine because ectopics never bleed, but my feedback facilitator said that was wrong and ectopics frequently bleed.  I was so confused about the whole thing, and just kept thinking of the worst case scenario. 

In the scanning unit I asked her consent to watch her scan and she actually seemed relieved to see a friendly, familiar face, rather than accusatory, which was good.  The waves of relief that washed over me as I saw the tiny flickering heart beat on the ultrasound is beyond words.  I later found out that she wasn't far enough along when she presented for the ED scanner to have found a heartbeat, so even if they did suspect something, there wasn't much they could have done and waiting for the EPU scan was the best option.  It just would have been nice to know that at the time so I didn't tie myself in knots at the weekend thinking I’d maybe missed something drastic.  I won’t forget that feeling in a long time. 

Most of the rest of the patients in the EPU scanning list were also happy endings.  They let us clerk in the patient and then watch them being scanned, so between us one was watching a scan and one was clerking the next patient.  One lady I was particularly worried about had been having really heavy bleeding.  When she was scanned, it transpired she had a bicornuate uterus, where the uterus is split into two lobes at the top and is sort of heart shaped.  She had a foetus in one half and the other half was having a regular period as it didn't know it was pregnant.  Very clever!

The rest of the week was spent in the Surgical Assessment Unit where I passed a competency in gastro exams and clerked patients.  We got to go to a lunchtime meeting for trainees where hospital staff from all over bring along an interesting case to discuss as a teaching aide.  That was actually pretty good, and I shall try to go to as many as I can.  They should be good AMK material.  

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