Tuesday, 29 November 2011

Irregularly irregular

I was at my last day of my GP placement yesterday, and i took an observed history of a patient with atrial fibrillation.

I asked about his palpitations, he told me how he feels odd irregular beats across his chest, and with all that in mind, i then did a cardiovascular exam, and what seems logical went out of my head..

i just went with my "routine" comment, feeling for the pulse and commenting: "the pulse is of sinus rhythm, regular, HR within normal ranges, symmetrical on both arms, there is no radial-radial delay.." this was when the Dr looked very worried and stopped me...

"Tofu... are u sure?! this man has AF!"

.. this was when i snapped out of my stupid routine and realised how stupid i was! i was almost day dreaming, and just repeating a routine... so so so stupid >.<

AF - is irregularly irregular! i should have known that from the history alone!

This was embarrassingly stupid, but in a way im glad it happened in hindsight. It annoys me how silly it was, but i guess it's a good time for me to realise i need to REALLY pay attention to things... to look, listen and feel for signs.. and not just assume patients are "normal".

I will take it as a learning experience.. going to never do that again!


Okay.. it's now croissant and coffee time, then off to my ward! (with a more serious approach to clinical examinations, no more relying on my safety routine comments!!)

Wednesday, 23 November 2011

Random Happenings

Random happenings:

I put in my first ever cannula!

the elderly lady was so lovely, and kept reassuring me the entire time... telling me how she was used to having needles stuck into her arm, and it won't hurt her at all. The fact that she was so nice, really did make a big difference, as i was relaxed and took my time to make sure i had everything where i needed it...and yay it went in first time! As soon as i stuck the cannula in, i got the flashback, and in it went!

I know in a few years time i will probably think "whats the big fuss in putting in a cannula" it might just be second nature in the future.. but for now, it's an entire new learning experience, and i just need to keep practising it.


Mitral Regurgitation

I heard my first mitral regurgitation with radiation to the axilla last week too, i was pretty excited!!

I've recently been converted to start listening at the mitral valve first, and then move through the different areas...and as soon as i placed the stethoscope onto the mitral valve position i noted the murmur! (this was when i realised i forgot to place my other hand on the carotid pulse to time it!)

I placed my other hand on the carotid pulse and identified a pan-systolic murmur.. i moved my stethoscope more laterally, and there it was! it radiated to the axilla region!!!

- i know it sounds so odd, but i've learnt the cardiovascular exam, more or less as a routine, and ive tried listening to the axilla many many times before, and never heard anything different, and nor did i expect to... but when i heard it there.. i can't explain it.. it was just different.

i told my bf about my experience and how interesting i found it... and he had to kill the moment, and tell me its nothing special and he's heard like 5 on his firm already ¬.¬ !!! ... well it was pretty exciting for me!!


Met3b OSCE!

My firm is quickly coming to an end, and i'm sadly going to really miss this place!
.... and on that note my firm has organised a mock OSCE for us this Thursday, with real patients from the hospital, with real signs to elicit and present back! This is a big BIG change from my first 2 years of OSCEs, where we've basically been examining healthy individuals.... it's going to be an interesting experience! .. i'm pretty sure i will moan about how difficult it was in my next post!


Endocrine firm is almost over...

My endocrine firm is almost over.. and in some ways it seems that way already..

My FY1 has nights this week, my reg has nights, the other reg has taken annual leave, and last but not least my consultant is going to a conference abroad on friday too... so it's just going to me and the locum this week.. it's going to be an interesting week..but hopefully.. it means a lot of random jobs for me to do!

the nurses like to joke, and call the medical students "vampires" and i guess they aren't too far off... the other student on the ward and myself always offer to take bloods... and its fun!


.... ok back to revising for ICAs!