Howdy to all, This is my second clinical posting since the COVID-19 pandemic, and I’m in Emergency Medicine this time. Initially, I was posted to Pediatrics, which was particularly a very productive time. Likewise, I’d like to make this a productive and knowledge-accumulating period as well.
I’m really looking forward to getting something new from the Emergency Medicine posting. But, as any medical student or doctor knows, the most critical area of a hospital is the Emergency Medicine department, therefore I have to adjust to the surroundings more than in any other clinical postings. Again, I don’t believe it will be a difficult task for me. Let’s see how it goes.
So, on my first day of Emergency Medicine, this happened. When I walked into the hall, there were my colleagues and two interns doing their jobs. After a few minutes of waiting, one of the interns approached us and instructed one of my batchmates to inject a cannula (Venflon). As a result, he went along with the intern and performed admirably. Then everyone volunteered themselves.
I didn’t do it on the first day since everyone was rushing after me to do so. In fact, I didn’t get the opportunity. The next day, I went back and asked the intern & took the cannula. That was a completely different feeling; I felt as if I was witnessing the beginning of a new age (joking). During my second-year practicals, I performed that IV, IM, and subcutaneous injections on a mannequin. This time, however, the hand was not made of plastic, but rather of a genuine human’s hand.
- I applied the tourniquet and palpated the peripheral vein,
- Then cleaned the region with cotton and spirit in a circular fashion from inward to outward.
- Finally, I inserted the cannula needle at a 20o to 30o angle.
- The needle was then advanced until there was a flashback of blood in the hub at the rear of the cannula.
- The needle was then withdrawn, and the cannula was pushed deeper into the vein.
Obviously, I watched a few YouTube videos of them that morning to learn how to do it properly. And it made things easier for me.
Saw a snakebite and a Burn case
The next day, our professor taught us the basics and asked us to visit the ward to see a snakebite patient who had recently been admitted. That was my first experience with a snakebite case. He had four bites on his left leg, which were accompanied by edema. Furthermore, the bite appears to be a single tooth bite. The staff took blood samples in order to do a 20-minute whole blood clotting test (20WBCT) to determine if the bite was caused by a viper, cobra, or krait.
Then there was the tragic event.
As we were returning to the classroom after seeing the case, a structure approached at a high speed, carrying a woman who had a fire accident. Because the burning source was kerosene, the entire region smelled like kerosene. We were all shocked since we had never seen or been exposed to anything like this before. All she had is the white basement layer on her skin, and all of her outer skin layers were peeled away. I noticed her tiny reddish eyes and felt bad for what had happened to her.
Chronic alcoholic case with withdrawal seizures
My Emergency Medicine posting had reached the fourth day. We were waiting for the professor, who had no clue we would be there on that particular day. When he arrived in the yellow zone from the red zone, he asked when did you come. We were looking at him with strange faces.
As he began examining and treating the patients, we observed a few cases, including a head injury, an accident, and an alcoholic patient with hypoglycemia.
He joined us after his treatment and started teaching us about head injuries. Suddenly, a woman screamed, and the alcoholic patient was thrown from his bed. Within seconds, the whole yellow zone was in a state of fear, anxiety, and intensity. Every nurse, CRRI, PG, and professor rushed up to him, pulled him up, and began treating him. The lady (the patient’s wife) was constantly disrupting the treatment, such as calling her husband to wake up in her words, not answering doctors’ questions regarding the patient, and continuously interrupting the treatment. Even all of us got triggered by her way of behavior. Of course, emotions will be there, but she chose not to let the professionals perform their jobs rather than hugging her husband for no apparent reason.
He was a chronic drinker for 17 years and was undergoing treatment for alcoholism. He gradually reduced his alcohol consumption and was advised to take a portion of it every day. For the record, he cannot be prescribed to withdraw from alcohol immediately after beginning therapy, since this would induce severe withdrawal symptoms.
His wife stated that he had been unwell and weak for the past 10 days because he had not maintained a proper diet. Later, the doctor’s advances forced her to admit that he had not taken the daily alcohol dose prescribed the last night.
Later the professor came to us and stated that he had an epileptiform seizure, which may have been caused by either not taking the alcohol dose last night or hypoglycemia. He gave him the lorazepam, and within half an hour, the patient was back to normal.
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Left sided Stroke case
This was my fifth day and this was the first time I actually went to a patient and asked the history. You know the format of history taking, I was doing that. In the chief complaint, he said he couldn’t move his left side limbs and body parts of his own. Also, he claimed this happened to him one year ago. And this time it happened after the first dose of Covishield.
To be honest till this point, I have no clue that stroke is a recurrent disease. Then I asked my colleagues and they don’t know either. I googled it after the history taking and the official NCBI said an analysis of routine data found that 11.3% of stroke patients, experienced a recurrence within 12 months. That was the take-home message that day.
When he stated he had the second attack right after the first dose of Covishield, I thought the stimulus may be due to the VITT (vaccine-induced immune thrombotic thrombocytopenia) side-effect of the Covisheild vaccine. But unfortunately, I had no comfortable zone to ask the professor that day.
Osteomyelitis case with Ulceration of sole
Typically this was my last day of causality posting. I reached there at the yellow zone at 9 o clock. We were asked to take history again. I was looking for the best one, to begin with. His name was Mr. Narayana Kumar. He came here because the wound on his sole was oozing fluids and causing him discomfort. When I examined his sole, I noticed a purulent ulcer. Then I move on to the further steps of history taking. He stated that he had been suffering from this for 6 years and that he underwent surgery last year.
I examined his past year’s reports, and he was diagnosed with Osteomyelitis. Then my whole pathology and microbiology knowledge began to merge in my brain. In addition, the microbiological examination revealed that no organisms had been identified (50 % fail to develop organisms in culture medium). I arrived at the provisional conclusion that it would be a femur staphylococcus aureus infection.
That’s all what happened in this short period of time in Emergency Medicine. Once I have this posting back, I’m hoping to update the balance of the stories. It may happen during my third-year finals, fourth-year, or intern rotation. Who knows, maybe.
I’d appreciate it if you could share your experiences about your days in the causality postings with me.
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