Tuesday - Day 2 in the Warzone

People rushing about, patients lying in trolleys breathless, with broken bones, or bleeding from multiple places.

I kid you not. That's how hospital emergency departments are like. I'm going to be attached there for 3 weeks.

Monday started off with the obligatory beginning-of-posting-debriefing, then an ueberly-long tutorial on reading ECGs. ECGs are those wavy diagrams that doctors use to determine the health of the heart, which are created by placing a bunch of electrodes on the patient's body.

Then, while the first shift went to the emergency department in the afternoon, my group sorta lazed around in NUS (QY and me having a lazy lunch at Subway and then shopping for laptop bags.)

And then, it was time for my shift. In the emergency department, one hardly gets any chance to catch his breath. The doctors are all too busy trying to keep the critical patients afloat, while tending to the other impatient patients.

As for students, we're all too busy absorbing all that information being thrown at us. The NUH emergency department has great teachers, and I can't say the same for any of the other departments of the hospital.

Monday night's full of breathless people.

Ended at 10pm. Tired. Took the bus home, groggy from tiredness, legs achey from standing and walking.

Dreamless sleep.

Morning again. Tuesday.

Morning's a tutorial on the assessment of multiply-injured patients, then part 2 of the ECG tutorial.

And an afternoon in the emergency department. The highlight was this multiply-injured patient (luckily we just had that tutorial!) who fell down 8 metres and was delirious. Blood pressure's falling from bleeding from a yet-unknown source, a pneumothorax (air inside the chest but outside the lung - impedes breathing), and blood from the ear (bad sign - likely skull fracture).

The professor allowed us to observe the emergency management of the patient, while the team scrambled to intubate (stick a tube down the throat to keep him breathing), run fluids into his veins, put in a chest tube, et cetra. And he let some of us get involved too.

Emergency medicine's exhausting. So much happening, so much needing to be done urgently.

Assisted in putting in a urinary catheter for an obese male. He was unconscious and intubated, so it wasn't all that bad when I fumbled around like an idiot, trying to clean the area. As in, experienced great and embarassing difficulty while handling the patient's genitals. (for meddies: I mean: suprapubic fat pad getting in the way of access)

Irony is, I was asking female nurses and a female doc for help to handle the male genitalia! Arrrgh.

My classmate managed to do it with the supervision of the doctor in the end. Yay.

And after that, another classmate and I were walking across some beds when we saw that someone's vital signs monitor was displaying a ECG reading that was rapidly zigzaggy.

Not good. It looks like the ECG of ventricular fibrillation I saw in the book earlier today. It's a deadly rhythm of the heart where the heart muscles go crazy and go into uncoordinated and ineffective electrical activity. In short, it means, the heart would thus be effectively not beating.

I got quite concerned. Looked to the bed of that vital signs monitor, and saw a man in his 70s looking and smiling to me.

Said hi, and he was chatty. Ventricular fibrillation patients are not chatty and comfortable. They're almost always unconscious and on the verge of dying. So, it's most definitely just a false alarm from a loose ECG lead. Whew.

Reminds me of Monday when I made my whole group laugh. Man with weakness and numbness in hands, probably due to a clogged artery.

I examined the hand. Saw the black spot on his thumb. Oh no. Is it gangrene?

"How long has your thumb been black?" I asked the patient.

The professor pointed out that the black mark was from him having just inked his thumb for a thumbprint. Yay. How ironic.

Tomorrow's basic Cardiac Life Support training, a 1 day thing, then Thurssday night I'm gonna tag along with an ambulance in order to get an exposure to the issues paramedics face and what they do before the patient gets seen in hospital. Looking forward to those!

(No pictures for this post, due to the immense medico-legal and privacy issues involved.)