Procedures and nights

Hi,

Sorry for the poor rate of posting - I have been very busy but that is always my excuse. I am now in a training post as an emergency medicine trainee. The hours are pretty rubbish, and I am working every weekend this month, but I love the job. I get to see a complete range of diseases and people every day and get to do a lot of different things.

I am on nights this weekend, but over the last week and this weekend I have seen people ranging from a 45 year old woman with vaginal bleeding 4 weeks following her last period (quickly diagnosed as her next period and discharged) to people in cardiac arrest and with severe burns and explosion injuries following bonfire night mishaps. 

I really like the procedural side of A&E, and the chance to get away from the constant push to see and discharge people before they 'breach' the 4 hour wait and sit in a room for 20 minutes and do some suturing or put a joint or broken bone back in place. Yesterday night (or this morning more accurately) someone came in with eye pain for 3 days following angle grinding some metal without eye protection. I am not an expert with the equipment needed to examine eyes (called the slit lamp, and often seen at opticians) but I could see a small piece of metal just over the iris (similar to the picture below)

Metal piece in eye, picture taken from Opthobook.com

I have not taken things out of the eye before, but remember being taught how to back at medical school. The registrar on had also not done this procedure before and was caught up with a sick person which we couldn't get venous access on, and was trying to gain access with the ultrasound machine. I thought I would have a gentle try and if failed, would have to get the person to come back to see the specialist tomorrow. I bent the end of a needle and managed to use that to get the metal out of the eye. Very rewarding, but nerve-racking, poking the end of a long needle towards someone's eye and repeatedly telling them they have to hold very still!!

I also had a patient last night/this morning who had abdominal pain and a large mass at the lower part which felt like it could be the bladder. I have not had any ultrasound training but am always in awe of the more senior A&E doctors who can rock up with the ultrasound probe and diagnose heart failure, PE, pneumothorax and so on in seconds at the bedside. I thought I would have a go with the ultrasound (no radiation, nothing to loose) to see if I could see if this was the bladder.We normally have a special machine called the bladder scanner to measure for bladder volume but our department's one broke 6 weeks ago and is still apparently being repaired... Positioning the probe over the bottom of the abdomen I could see the large circular bladder, and using the measuring tools on the USS it was massive. We put in a catheter and 1 1/2 litres drained out. Although this is a very simple thing, it was very rewarding to be able to work out how to do something, make a diagnosis and be able to make a clinical difference to that patient.

I also managed to do a special nerve block to the femoral nerve for a lovely 90+ year old lady with a hip fracture last night/this morning as well! 

As you can see I have been doing loads with my shifts, and feel like I am learning lots of new useful skills. Sadly I have one of my professional exams coming up and having sunk over £300 into it I now need to spend much of my free time revising, as it is coming up next month! It seems there is no rest for the wicked.

Finally, I really hope that as junior doctors we do not need to strike, and the BMA and the government manage to re-enter negotiations, but given all of the poisonous rhetoric being put out but Jeremy Hunt, and the hatchet jobs appearing in news papers (most recently today in the Mail on Sunday) I think that it may well come to that. This is a huge shame, but a small price for us as a country and profession to pay for continuing the good work that the NHS can provide and preventing the destruction of the NHS and many doctor's lives.