Specialisation... where to from here?

Wow! Long time no post. My apologies to all.

It is almost the end of the year... Meaning almost the start of a new year. Hence an update to the template. Have been considering moving over to wordpress, but no time to find out how to.

Anyway thoughts of the day...

Its now been a few years post medical school. The question is where to from here? Ideally chose a specialty, get in, and away you go. I guess there was a misconception that it was this easy. Unfortunately its not. Specialty training is competitive. It requires hard work, dedication and long hours.

So whats the alternative? look for a plan b. avoid getting depressed.

But at times like this, when you have a chance to take a step back, sometimes you have to take stock of your life and where it is headed. What is the overall game plan? Is it merely taking one step at a time? What if that way is not clear or blocked?

In the end, medicine is a job. And like any job, there is more to life than work. But where is your endpoint? Is it to have a family? Open a business? World peace?!

My suggestions

- Try not to get fixated on one aspect of your life

- Sometimes things do not always work out the way that you would expect, however these things have a of working themselves out in the end

- Remain in a positive frame of mind as thing will always help you cope with the stresses of life

The Resus Room - Arterial/Venous Bleeds

Today there was an exciting resus. Sometimes it is hard to manage when patients are going crazy. Self-inflicted wounds in a crazy patient. Not always the easiest situation to manage.

Now, when you can see the contents of the cubital fossa, which have nicely been opened to you by the patient, have they injured a vein? or an artery?

Well when you see blood spurting, it tends to be more arterial. Now judging by the colour of the blood, you can have a guess whether it is arterial or venous. Venous being darker. And also today, I learned that by applying your knowledge of anatomy, and probing the wound to assess the depth, you can get an idea. Arteries tend to run deeper.

Now if you are wondering why I have used the word "tend" a lot in the previous paragraph, is because these arent hard and fast rules. I have seen arteries that dont pulse, with blood that looks dark. So sometimes it can be a bit hard to tell.

Ah well, the resus room can be an exciting place! And remember, the wonders of IV midazolam and ketamine.

Chest Pain

Not all chest pain is cardiac. Today was chest pain day. A million chest pains came in. Not all chest pain is cardiac.

Other friendly things to consider,

• PE
• Aortic Dissection
• Pneumonia
• Musculoskeletal

I believe from an emergency perspective, probs better to overinvestigate than under. Unless you are willing to put your career on the line.

Lets just review the changes to an ECG during MI.

Initially hyperacute T waves with ST elevation. Within hours to days, there is T wave inversion and development of Q waves.

Pericarditis changes include a saddle shaped ST segment elevation which is diffuse.

What if you dont know what's the diagnosis?

There have been many times in which I had no idea what the diagnosis was. In Emergency, this a bit difficult to deal with, as usually its nice to give people a reason as to whats causing their pain. I was given some good advice today.

Basically a high percentage of cases never get a diagnosis. For example abdominal pain, or chest pain. It is sometimes tempting to label these people with gastritis, or gastroenteritis. However I was told if you really dont know, you should probably just discharge with a diagnosis of No specific illness found.

The reason for this, is that when people look back on their case notes later on, they will realise that actually we didnt know, instead of seeing, oh this patient has come in 3 times with gastro, when actually they may have had a AAA.

Manual Disimpaction

Today I had to manually disimpact an old lady. She was quite happy. I was quite not. The only suggestion I have, is that if they have any bowel control, to ask them to help you push. Like delivering a baby. I can also stress the need to double gloving.

In terms of post disimpaction cleaning. Wash all clothes. Then wash the hand with soap three times. Mainly concentrating on the primary finger. Post that wash had with some type of alcohol based substance, such as aftershave. Following this, have a long hot shower, and then rinse thoroughly with listerine. And there you go, should be good as gold.

Ward Rounds are best done in the morning...

Today was hectic. Because our ward round was done in the afternoon. So it sucked. Plans were made in the afternoon which is fine. What wasnt fine was that there was to time left in the day to execute those plans, and the junior team was thrown into disarray. Therefore to avoid confusion, its best to do it in the morning, when staff still have the will to carry out the plans.

Be Nice to Patients

I've realised that patients really appreciate it if you take time out to talk to them. Just to see how they are not. Don't just walk past cause it will take too much time. If you get some time, then just briefly stop by and ask them how they are going . Then they will feel like they are cared for. Be friendly, caring and the small groundwork that you put in place will pay off many times over.