The weird and wonderful things in Emed keep me coming back… but there are also the same things that make me not want to go back. Doing Emed in the same hospital as my M4 posting has its perks, but I would really like to see how it is like in the other institutions as well. TTSH is super popz, sigh.
Did 3 days of Emed this week with an MO who recently came back from army and is also pretty lost hahaha but it’s ok. I don’t feel as much as a burden that way. Hopefully I’ll fulfill my agendas for the next few weeks:
- Bloodsssss and please let me do better sigh. Need to up my game and stop succumbing to small/old people/fragile veins. How many more veins do I need to poke to have a higher 1-time-success rate? -.- [On a side note, the MO is really nice and patient though – “never mind, everyone needs to start somewhere”… ahhh I’m going to be as nice to my juniors in the future. And another MO also pointed out why I bumped a vein… cos I withdrew the needle when the plastic tube is not in the vein yet, so even with flashback, it’s not really in yet. She even took a cannula and showed me the difference in length etc, ahhh so nice.]
- Hx and PE. I’m so so so so so mighty rusty zzz.
- Mayyyybe do other hands-on stuff too.
Anyway, I like the weird cases and seeing things that I have never seen but read about before! Cool stuff this week:
- Dislocated prosthetic hip joint. Auntie presented with 1 mth knee pain, able to bear weight and walk. No obvious limb shortening/internal rotation/adduction. Omg the reduction in the ED was massive work… 1 big guy standing on the bed and pulling the leg, and 2 other people providing countertraction, and still didn’t succeed. Apparently it is more difficult to reduce a prosthetic joint due to the altered anatomy and smaller joint.
- Ruptured tendoarchilles. Uncle was referred by the GP to rule out DVT due to swelling and acute pain of the lower leg and ankle. Notably, he has a history of Archilles tendinitis, treated repeated with analgesic injections. There was bruising on the medial aspect of the foot and swelling (pitting though, strange) and a gap felt along the tendoarchilles. Simmonds test was positive. Functionally ok, he was able to plantarflex and walk. Hahaha I did not think of the diagnosis initially, just thought the foot looked weird and the gap was weird. Pretty lovely to see things I didn’t see in Ortho. Oh helped with the front slab too heh.
- First presentation of hyperthyroidism (tachycardia and tremors). Lady was referred by Polyclinic to rule out thyroid storm. Burch Wartofsky score was only 5 though. Anyway, she had other symptoms like heat intolerance and palpitations. Examination revealed a soft and smooth diffuse goitre… no other signs. Would be cool if she had eye signs and stuff but never mind. TFT showed a primary hyperthyroidism picture.
- G3P2 with PV bleeding which turned out to be a failing pregnancy. Thought this was interesting cos she was amenorrheic for 5 weeks, did 2 UPTs 3 days ago which were positive but the 2 UPTs she did in the ED were negative. Didn’t do speculum in the ED, but did a transabdo ultrasound and saw something flickering in the uterus but no gestational sac (actually kinda forgot when you should see what alr zz). Anyway, ObGyn came to see and also reviewed the serum BHcG and apparently it was a failing pregnancy. Actually thought this kinda thing need to trend, but if it is already low, means failing already?? Need to consult my ObGyn friend…
- Random ultrasound guide from the ED doctors. One when the doctor was doing the transabdo ultrasound for the lady, once when I was chaperoning another doctor and he was doing abdo ultrasound to look for gallstones and acute cholecystitis. And he randomly scanned the kidneys just to show me and let me try out on the patient without even asking the patient hahaha.
Despite the cool/fun stuff, there’s also a disproportionate amount of non-specific, truly undifferentiated cases. Really makes me wonder what to do when I run into a dead end when trying to come up with a diagnosis next time. It feels like maybe only 5% of the textbook translates into real life, sigh. Even a stroke can look super un-strokeish. The UMN signs take a while to develop, then the power may have already improved by a bit too. Takes quite a bit of experience to learn to use other aspects as discriminating factors between the differentials I suppose.