Saturday, 10 August 2013

Emergency Medicine SSU

For my next Special Study Unit I was lucky enough to spend 3 weeks in the Emergency Department at Derriford hospital, the trauma centre for the South West. I was in heaven, it was simply the best three weeks of the whole year. I had such a blast! We were completely immersed into the team. We had sessions we had to go to, but apart from that we could turn up when ever we liked, go and see whatever and whoever we wanted. It was amazing. Our brief was to get stuck in and see as many patients as possible. From the computer system we could see who’s next to be seen and what the triage nurse had said was wrong. Then we had to clerk them in with a full history and examination and then go and hover until the next free doctor is about to pick them up onto their case load. We presented back to the Doctor with a concise history, impression and management plan and the Doctor sends you off to get some bloods done. Then you go and see the next patient. If something exciting was going on in resus we could go off and help with that, or we could go and spend some time in minors clearing patients there. I saw and learnt so much over those three weeks. My examination skills and history taking skills improved immensely and I really didn’t want to leave at the end of the three weeks. It honestly felt like coming home, I have found where I fit in medicine. It’s the only place I’ve been to where you look up and four hours have gone by in a flash and you haven’t stopped but you still have plenty of energy and could keep going. I did an 8am-6am shift with a total of 5 hours off throughout the course of the day and could have kept on going. Although I do realise that if you do that everyday, you probably won’t still have the same amount of energy and enthusiasm. But for these three weeks, it was incredible.

Everything comes to the door and you get to be the first person to listen to them and say you know what, this is rubbish what has happened but I hear you, I understand and I will help you figure it out. We had all sorts, from strange rashes, drunken teenagers, fibromyalgia, epilepsy, pneumonia, fractured neck of femur… I could go on.

A few of the more interesting ones I saw:

- A gentleman with an irregular heart rhythm was bought in, and to differentiate between the different types we gave him adenosine to slow is heart rate right down to see the underlying rhythm. It was atrial flutter in the end, which has a characteristic saw tooth baseline on the ECG. Patients must be counselled before you give adenosine as whilst the heart is stopped they often report a feeling of impending doom which can be quite unsettling.

- An elderly lady tried to commit suicide by jumping from a third storey window. She broke every bone in her body but still survived.

- I got to be in charge of airways in a trauma call for a man that fell and hit his head. Because I was at the head end it was my job to keep talking to him and I felt so privileged to be able to be with him in what must have been such a scary time.

- A man with mental health problems was rushed in having stabbed himself in the stomach with a blunt dinner knife. He had done this so many times before his abdomen is full of fistulas and this time he was only millimetres away from hitting his aorta.

- A grandson bought in his granddad who’d had a cough for a few weeks and was now short of breath and off his food. The granddad had been refusing to see a doctor until this point. I stood next to the relatives as they were told the cough and shortness of breath was caused by fluid on the lungs from cancer of an unknown primary source that had metastasised all over his body. Hearing that diagnosis felt like I’d been punched in the stomach and it wasn’t even my family. It was so unexpected and heart breaking.

- A blood curdling scream was heard from resus so we rushed in to have a look. A man had been bought in an hour earlier with a lambing band (used to dock lambs tails) that he had wrapped around one of his testicles. This had been cut off and he was waiting for a psych referral to come through. The only damage he had sustained was a small tear in the skin of the scrotum. Whilst being watched by a policeman and a nurse, he had managed to put his fingers in the tear, open it up and remove the testicle from the scrotum. Still attached, he rolled over and it was lying on his hip, where the nurse saw it, and screamed. He was taken to theatre where it was sewn back in and then transferred to a secure mental ward. His belief was that with his testicles attached his head would explode. He’d spent two weeks furiously masturbating, to see if that helped, and then decided this was the next best thing to do. On the psych ward, he later tried to tie them off with a shoe lace, but was stopped and I heard he is now feeling much better.

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