A job a dream job offer!!
More to follow, out.
Friday, 29 July 2011
Wednesday, 27 July 2011
Med school exam
Everyone in the room looked so young!
Or perhaps I was the old one.
I am. I was probably the oldest one in the room.
Now that makes me feel old.
Some of them were stressing. Quite a bit.
"OMG! I'm like TOTALLY freaking out."
"Sh1t! I forgot my school ID!!!!!" (Runs out of the examination hall)
"Breathe.... breathe... breathe..."
I couldn't say I was stressing. Perhaps old age had dulled it down for me. Or that this was like my 7th time sitting this exam.
Yeah, I know I'm dumb.
But I liken getting into medical school like a lottery. Only that the lottery has better chances.
I'm quitely optimistic... but not getting my hopes up.
Or perhaps I was the old one.
I am. I was probably the oldest one in the room.
Now that makes me feel old.
Some of them were stressing. Quite a bit.
"OMG! I'm like TOTALLY freaking out."
"Sh1t! I forgot my school ID!!!!!" (Runs out of the examination hall)
"Breathe.... breathe... breathe..."
I couldn't say I was stressing. Perhaps old age had dulled it down for me. Or that this was like my 7th time sitting this exam.
Yeah, I know I'm dumb.
But I liken getting into medical school like a lottery. Only that the lottery has better chances.
I'm quitely optimistic... but not getting my hopes up.
Thursday, 21 July 2011
Be careful of what you wish for
I've had a student with me this roster. She's good to work with, very relaxed and we've had some good medical work.
Like many ambulance personnel, she's quite fond of trauma and wanted to experience working with patients with trauma.
"Be careful of what you wish for..." I warned on numerous occasions.
I personally don't mind trauma, but don't particularly relish it either.
Still, our shifts were rather uneventful.
Our last night shift was rather busy and we've had very limited sleep. 30 minutes prior to handover to the receiving crew, the pager buzzed.
"Priority 1, Some-road-very-far-away".
Bleh.
The radio dispatch came through.
"If you can now proceed to Some-road-very-far-away for a truck versus tree. Patient has been ejected, query unconscious, query not breathing, disembowelment. You'll be on case number 1192 at 0732 and your priority is 1."
She became rather excited.
~~ 35 minutes later ~~
We could see quite a fair way off into the distance, given the flat terrain and relatively clear vegetation. We could, therefore, see the accident scene about a kilometre beforehand and we could see a number of cars parked off the side of the road and a police car with beacons flashing warning traffic.
We pulled up past the police car and prepared to get out with the trauma kit and oxygen.
The police officer turned and shook his head at us.
Obviously there was no point.
Still, we had to look to confirm death (or otherwise).
About 100m from the road, amongst some trees, rested a very damaged flatbed truck. The front cabin had suffered significant damage and the entire right door and seat had been ripped away. It was obvious that the truck had ploughed diagonally from the opposite side of the road; vegetation damage include three splintered trees and crushed undergrowth marked the route.
As we walked closer to the truck, we could see a blanket on the ground, about three metres behind the rear. Lifting up the blanket revealed a young man, obviously deceased, with a traumatic amputation to his right thigh ripping up through the groin and leaving a small broken edge of femur. He appeared to have exsanguinated from the massive blood loss from his femoral artery and this was supported by the large volume of blood (and attracting a huge number of ants) on the ground.
I turned to my student - we still had to go through the rigmarole to confirm death. This was her first death so I guided her through the process... check for carotid pulse, auscultate for lung sounds, auscultate for apex heart beat, check pupils and obtain an ECG strip.
Covering the poor fellow up, the police and ourselves hunted for the amputated leg.
It wasn't overly difficult, thankfully, as we followed the truck's route back towards the road. Wedged amongst a group of shrubs and a now-destroyed tree was a very disfigured truck door, part of the seat and the fellow's leg / groin. As it was a crime and investigation scene, we weren't allowed to move it, but we did cover it up with a sheet for some dignity.
There wasn't much to say, but we were able to provide some support to the bystanders on scene whom, naturally, was quite traumatised.
Our long drive back to our depot was rather quiet and sombre. Not exactly a great way to finish off a roster.
Be careful of what you wish for and please drive safely!!!
Like many ambulance personnel, she's quite fond of trauma and wanted to experience working with patients with trauma.
"Be careful of what you wish for..." I warned on numerous occasions.
I personally don't mind trauma, but don't particularly relish it either.
Still, our shifts were rather uneventful.
Our last night shift was rather busy and we've had very limited sleep. 30 minutes prior to handover to the receiving crew, the pager buzzed.
"Priority 1, Some-road-very-far-away".
Bleh.
The radio dispatch came through.
"If you can now proceed to Some-road-very-far-away for a truck versus tree. Patient has been ejected, query unconscious, query not breathing, disembowelment. You'll be on case number 1192 at 0732 and your priority is 1."
She became rather excited.
~~ 35 minutes later ~~
We could see quite a fair way off into the distance, given the flat terrain and relatively clear vegetation. We could, therefore, see the accident scene about a kilometre beforehand and we could see a number of cars parked off the side of the road and a police car with beacons flashing warning traffic.
We pulled up past the police car and prepared to get out with the trauma kit and oxygen.
The police officer turned and shook his head at us.
Obviously there was no point.
Still, we had to look to confirm death (or otherwise).
About 100m from the road, amongst some trees, rested a very damaged flatbed truck. The front cabin had suffered significant damage and the entire right door and seat had been ripped away. It was obvious that the truck had ploughed diagonally from the opposite side of the road; vegetation damage include three splintered trees and crushed undergrowth marked the route.
As we walked closer to the truck, we could see a blanket on the ground, about three metres behind the rear. Lifting up the blanket revealed a young man, obviously deceased, with a traumatic amputation to his right thigh ripping up through the groin and leaving a small broken edge of femur. He appeared to have exsanguinated from the massive blood loss from his femoral artery and this was supported by the large volume of blood (and attracting a huge number of ants) on the ground.
I turned to my student - we still had to go through the rigmarole to confirm death. This was her first death so I guided her through the process... check for carotid pulse, auscultate for lung sounds, auscultate for apex heart beat, check pupils and obtain an ECG strip.
Covering the poor fellow up, the police and ourselves hunted for the amputated leg.
It wasn't overly difficult, thankfully, as we followed the truck's route back towards the road. Wedged amongst a group of shrubs and a now-destroyed tree was a very disfigured truck door, part of the seat and the fellow's leg / groin. As it was a crime and investigation scene, we weren't allowed to move it, but we did cover it up with a sheet for some dignity.
There wasn't much to say, but we were able to provide some support to the bystanders on scene whom, naturally, was quite traumatised.
Our long drive back to our depot was rather quiet and sombre. Not exactly a great way to finish off a roster.
Be careful of what you wish for and please drive safely!!!
Tuesday, 12 July 2011
Le Fort fracture
A police officer held her head in alignment against the back of the seat; an improvised airway temporarily inserted using a plastic breathalyser stick. Blood covered her ungloved hands, staining them bright red.
"Spine board?" I queried.
A nod of agreement by Amy.
No time for proper spinal precautions, no time for a KED. 30 seconds later and we were out of the driver's seat and into the back of the ambulance.
She didn't look good.
Small arterial bleed above the eye and some visible brain matter, gurgled respirations exiting with bubbling around the mouth, significant flow of blood from the mouth, massive head and facial trauma, deformed thigh. GCS 6, HR 132, RR 28, SpO2 79% RA, BP 70/40.
Backup in the form of a Critical Care Paramedic and Operational Manager arrived fairly soon after, despite the peak hour traffic.
A laryngoscope was inserted but with significant facial fractures and an ongoing stream of blood in the oral cavity even with suctioning, it was near impossible to lift the palate let alone visualise the trachea.
"Let's go!" we all concluded.
It was pretty useless inserting an LMA as that would just pool the blood and offered limited protection into the trachea so instead a size 3 OPA was inserted with supportive ventilation and suctioning. 16g cannula and 1.5L of fluids helped to increase the BP to 100 systolic, but it was a fine line between increasing blood pressure and increasing the facial / cranial bleeding which we couldn't control.
The 20 minutes to hospital seemed like an eternity.
************************
Further investigations at the hospital found she had a Le Fort III fracture, which probably explained the difficulties we had with field intubation, a depressed fracture of the skull and significant head injuries. She passed away in ICU 3 days later.
"Spine board?" I queried.
A nod of agreement by Amy.
No time for proper spinal precautions, no time for a KED. 30 seconds later and we were out of the driver's seat and into the back of the ambulance.
She didn't look good.
Small arterial bleed above the eye and some visible brain matter, gurgled respirations exiting with bubbling around the mouth, significant flow of blood from the mouth, massive head and facial trauma, deformed thigh. GCS 6, HR 132, RR 28, SpO2 79% RA, BP 70/40.
Backup in the form of a Critical Care Paramedic and Operational Manager arrived fairly soon after, despite the peak hour traffic.
A laryngoscope was inserted but with significant facial fractures and an ongoing stream of blood in the oral cavity even with suctioning, it was near impossible to lift the palate let alone visualise the trachea.
"Let's go!" we all concluded.
It was pretty useless inserting an LMA as that would just pool the blood and offered limited protection into the trachea so instead a size 3 OPA was inserted with supportive ventilation and suctioning. 16g cannula and 1.5L of fluids helped to increase the BP to 100 systolic, but it was a fine line between increasing blood pressure and increasing the facial / cranial bleeding which we couldn't control.
The 20 minutes to hospital seemed like an eternity.
************************
Further investigations at the hospital found she had a Le Fort III fracture, which probably explained the difficulties we had with field intubation, a depressed fracture of the skull and significant head injuries. She passed away in ICU 3 days later.
Sunday, 10 July 2011
I'm okay, seriously.
1.3 read the machine.
That's in mmol/L. Or 23.4mg/dL, whichever way you like it.
"I don't believe you." he stated, matter of factly. "I'm okay, seriously."
He continued.
"Plus, I don't believe your machine. Do it with mine."
My partner and I shrugged. This patient was going to be stubborn, but hey, it didn't bother us - I'll happily use his glucometer. Thankfully, he wasn't getting violent and still was relatively logical given his hypoglycaemia.
His glucometer was much faster thank our dodgy one. 1.5 it read.
Still way too low. And he wasn't okay. Thankfully though, he was convinced enough to drink his glass of coca cola.
Nevertheless, he still continued to argue.
"There's no need for you to be here. This coca cola will last me for a good 30 minutes. Plus the fructose will take hours to digest."
True, but that still doesn't make our treatment any less.
AmboPartner explained. No, we can't leave and no, we won't leave until your BSL is normal and remains so.
This time, it seemed to have got to him and he finished off another glass of coca cola.
5 minutes later, we try again.
2.8.
"See, it's great! And it's working. You can go now..." he exclaimed.
Not quite. It's still too low. We make a sandwich, it's the long term carbohydrates that will increase his sugar level and make it stay that way.
Plus another coca cola.
"You know there's like 50% sugar in this", pointing at the can of coca cola.
"Err... yes. That's the point" half serious, half laughed. He was a smart old geezer.
20 minutes, 2 sandwiches and 2 cans of coca cola later, his BSL read 7.0.
Another feel good success story.
That's in mmol/L. Or 23.4mg/dL, whichever way you like it.
"I don't believe you." he stated, matter of factly. "I'm okay, seriously."
He continued.
"Plus, I don't believe your machine. Do it with mine."
My partner and I shrugged. This patient was going to be stubborn, but hey, it didn't bother us - I'll happily use his glucometer. Thankfully, he wasn't getting violent and still was relatively logical given his hypoglycaemia.
His glucometer was much faster thank our dodgy one. 1.5 it read.
Still way too low. And he wasn't okay. Thankfully though, he was convinced enough to drink his glass of coca cola.
Nevertheless, he still continued to argue.
"There's no need for you to be here. This coca cola will last me for a good 30 minutes. Plus the fructose will take hours to digest."
True, but that still doesn't make our treatment any less.
AmboPartner explained. No, we can't leave and no, we won't leave until your BSL is normal and remains so.
This time, it seemed to have got to him and he finished off another glass of coca cola.
5 minutes later, we try again.
2.8.
"See, it's great! And it's working. You can go now..." he exclaimed.
Not quite. It's still too low. We make a sandwich, it's the long term carbohydrates that will increase his sugar level and make it stay that way.
Plus another coca cola.
"You know there's like 50% sugar in this", pointing at the can of coca cola.
"Err... yes. That's the point" half serious, half laughed. He was a smart old geezer.
20 minutes, 2 sandwiches and 2 cans of coca cola later, his BSL read 7.0.
Another feel good success story.
Friday, 8 July 2011
Stop pushing
Bent over, legs outstretched and off to the side open for the world to see, she let out an enormous long winded abdominal grunt.
Everyone in the room shot off strange looks.
"Come on, let's get you out to the ambulance. You can't have your baby here..." trailed off AmboPartner. He was doing great, using a softly softly approach though it didn't quite seem to be working.
"IT'S COMING! MY BABY IS COMING!!!" she screamed, at the top of her voice.
"What'd she taken?" I asked the nearest police officer.
She shrugged.
"Stop pushing. You're going to hurt yourself." AmboPartner attempted again, in a more assertive voice.
She was in her own little world, so the five of us half supported and half dragged her onto the nearby stretcher.
Seatbelts appeared at lightning speed and a minute later, we were out of the police cells and into our awaiting ambulance.
A young constable rode with AmboPartner in the back as we drove quick smart to the hospital.
-----------------------------------------------------------------------------------------------
"Has she taken anything?" asked the nurse.
"Quite a bit of alcohol and some sort of drugs... we think."
10mg of Midazolam later, she was still sitting up, abusing the attending doctor and nursing staff.
Final diagnosis: Drug induced acute psychosis. And she wasn't pregnant.
Everyone in the room shot off strange looks.
"Come on, let's get you out to the ambulance. You can't have your baby here..." trailed off AmboPartner. He was doing great, using a softly softly approach though it didn't quite seem to be working.
"IT'S COMING! MY BABY IS COMING!!!" she screamed, at the top of her voice.
"What'd she taken?" I asked the nearest police officer.
She shrugged.
"Stop pushing. You're going to hurt yourself." AmboPartner attempted again, in a more assertive voice.
She was in her own little world, so the five of us half supported and half dragged her onto the nearby stretcher.
Seatbelts appeared at lightning speed and a minute later, we were out of the police cells and into our awaiting ambulance.
A young constable rode with AmboPartner in the back as we drove quick smart to the hospital.
-----------------------------------------------------------------------------------------------
"Has she taken anything?" asked the nurse.
"Quite a bit of alcohol and some sort of drugs... we think."
10mg of Midazolam later, she was still sitting up, abusing the attending doctor and nursing staff.
Final diagnosis: Drug induced acute psychosis. And she wasn't pregnant.
Friday, 1 July 2011
Back home
I've enjoyed the last 13 months as an aid worker.
It's been fun - though not without its challenges, blood, sweat and tears.
However, it's time to finally call it a day and to head home.
I leave more humbled and with an open mind. I know I am a lucky young man to have been given the privilege to serve and work in a very disadvantaged country. I am grateful for the luxuries I have back home - clean water, 24 hour electricity, an education, road rules, actually having roads.
So Long and Thanks for All the Fish.
It's been fun - though not without its challenges, blood, sweat and tears.
However, it's time to finally call it a day and to head home.
I leave more humbled and with an open mind. I know I am a lucky young man to have been given the privilege to serve and work in a very disadvantaged country. I am grateful for the luxuries I have back home - clean water, 24 hour electricity, an education, road rules, actually having roads.
So Long and Thanks for All the Fish.
Subscribe to:
Posts (Atom)