ED / ER / A&E / Casualty
ED work's totally different from ward work. Having done 2 days of work in the ED I am feeling very incompetent. not only can i not remember a lot of what i knew back in med school, i've realised that my knowledge is also deficient in a lot of other areas. Deciding if something is severe and needing more urgent and drastic measures is one challenge. Knowing how long to observe a patient before you discharge them home is another.But the biggest question is to admit or discharge. If i dismiss the presentation as relatively trivial and not needing any medical attention that a hospital (rather than say GP) should provide and send the patient home, there's always the chance that i could missed something and that the patient's condition worsens after leaving hospital. This is what scares me. In non-ED rotations, even on evening/night shifts, the patients are already inpatient. Whether you do something or not, they are not going anyway, should their condition deterioate, it'd be picked up much sooner by the nurses or other medical staff.
And i am slow. On my first 10 hr shift, i saw 4 patients. And on the next 10hr shift i saw 5. Have to see 2-3 patients at the same time. and it never ends, there's always patients in the waiting room. been told not to worry about how much patients i see during each shift, cos it's how well i manage each that matters. But this leads back to my first problem. I don't think i am managing them as well as i should. Been "screamed" at twice by this VMO already for not ordering some test. (My excuse was that, i'd considered ordering them, but didn't think the patient unwell enough to warrant those tests.)
Anyway, one good thing about ED's that i have a lot more time on my hand. only 40-45hrs a week, although they are rather strange hours of the day. So now, i've got more time to sleep these days, and less nagging from parents. (Really makes me wonder sometimes, well, all the time, why my parents didn't research enough into medicine as a career when they told me to do it. cos having medicine as a career totally conflicts with the kind of healthy lifestyle that they strive for and want me to have a passion for as well)
Saw a pretty sad case on wednesday. a young man came in with only one episode of vomiting. a Category 5*. so sat in the bed for hours to be seen by a doctor. When someone finally got to him, he was totally stuporous/unconscious/unresponsive. Apparently, it turn out to be an intracranial bleed with extension to the ventricles!!! So there was a lot of action in the resuscitation bay, then urgent transfer to *the tertiary/main/biggest hospital* under neurosurgery. Poor guy, hope they were able to do something for him, ?like an urgent decompression and that there's not too much neurological deficit. But from the history, it doesn't sound good. =(
* patients that present to ED are first seen by the triage nurse who will put them in one of Categories 1 to 5 depending on the severity of the symptoms/suspected diagnosis. Category 1 patients need to be seen by a MO within 1 minute, category 2 within 10 min ... category 5 within 2hrs. Usually patients under C1 & 2 actually do get seen within the times set, but C3-5 hardly ever get seen within the times set, because there just aren't enough MOs.
posted by zhinger @ 9:35 pm
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