Wednesday, 22 May 2013

Drugs smuggler


Hi,


Back working on the wards, sadly. We are meant to be preparing for next year when we work as doctors by getting used to the F1 job, but it also seems like a cheeky way to get people to work in areas of the hospital for free! Either way, I have had a pretty good week, so I don't have anything to complain about. I had some lectures and courses at the start of the week, getting my ILS certificate, then spent some time in the emergency department (where I think I may want to work later in life) and in anaesthetics.

The time in the emergency department was fun, and I spent most of it clerking in patients, which  involves taking a structured history and examination, and planning what initially needs to be done for them. I have forgotten a remarkable amount already since my exams, it is very embarrassing! The most interesting cases I saw were someone who had come in with a police escort after eating a lot of heroin to try and smuggle it into the country (but it had ended up in his bloodstream instead) and a Lady (as in Lords and Ladies) who used to be famous for her organised charity work, but had succumbed to advanced Alzheimer's disease (very sad). I hate diseases like dementia. As well as making you ill, the take away who you are/were, making it really difficult for the family as well. Who knows what will happen in my (and your) lifetime to change how these diseases effect us, perhaps removing them all together. Well, we can hope!

Other than working in A&E, I also spent some time in anaesthetics this week, and observed the anaesthetics for several different types of surgery. I saw breast surgery including removal of tumours, and someone having a breast reduction on one side to balance their breasts which were asymmetrical. This was all pretty 'normal' and I got to practice putting in certain airways and inserting cannulas. The most interesting case here was a patient who had received a blue dye during surgery to locate the lymph nodes draining from a breast cancer so these could be removed as well. This dye had spread throughout her body and she looked very blue and cyanosed, looking very ill despite being well. A good thing to remember in case it leads to panic on the wards when you think someone is becoming very ill, whereas their 'smurf-y' appearance (technical words...) should only last about 24 hours before fading away.

The other procedures I saw in anaesthetics were based around operations on the throat and airway (trachea). These are complex, as the airway needs to be used to breath for the patient, while it is being operated on. Some of the operations involved using a high pressure of gas, like a tyre pump, to inflate the lungs by blowing it down at high pressure from above the level of the operation. Exciting! One of the others was very interesting as it involved an operation to fix the vocal chords in a certain position and the patient had to be asleep for the operation (from outside the neck inwards) but woken up at intervals to check his voice. Very complicated for the anaesthetist, who had to control the level of conciousness with drugs into the blood stream (as couldn't use the airway to get any drugs in), and didn't want the patient to wake up at the wrong time. Something called a BIS monitor is used in this case to tell how 'awake' or asleep the patient is. This gives a score of 1-100 based on how 'awake' you are, and is shown on the image below. I tried it out and it told me I was unconscious. It had been a long day, but I think it was because it wasn't attached properly. Either that or all those finals exams have broken my brain! 


A BIS monitor showing 97 (awake and alert)

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