Bronchoscopy Part One: 2 patients presenting with haemoptysis

RESP FIRM
-------------------------------------------

Yesterday morning I stumbled into the hospital with my ward partner, located the bronchoscopy room, and then proceeded to resist the urge to fall asleep whilst waiting outside for the doctor to arrive.

The GP (for my gp placement), and the 5th years at the hospital have been warning me with their experiences of watching bronchoscopy, but being the ever so slightly odd medical student... i was really looking forward to finding out what the fuss was all about! To be honest.. it really wasn't that bad, mucus doesn't really phase me, if anything, i found the scared and distressed patient more uncomfortable to watch than anything else.

Patient 1:

The first patient was terrified, and had been referred for the procedure, having recently been coughing up blood.

This was her 4th Bronchoscopy procedure attempt, having failed to complete the bronchoscopy 3 times previously. The last time, she struggled and yanked the broncoscope out herself, mid procedure. However, she was willing to give it one more go, "i've had enough", starting to get slightly tearful as she propped herself onto the bed.

We popped apron, mask and gloves on, and in a flash the Dr had popped the cannula into the patient's hand, and administered the sedatives. However, although sedated, the patient was still quite distressed, she wanted to carry on, but was struggling to stay calm as the bronchoscope meandered its way through the conducting airways. I felt terrible, as the Dr asked the other student and myself to hold the patient's hands, and keep her calm and still, when she was clearly quite distressed. However, the patient's bravery got her through the procedure, and finally on her 4th attempt, they managed to have a good look, and take samples for testing. The patient was simply relieved to finally having it done, and not needing to go in again.

Patient 2

A very similar presenting story as patient 1, but this lady was very different! She was calm, almost a complete 180 of the previous patient; smiling, relaxed and just wanted to get the investigation over and done with.

This was a slightly more complicated procedure, as the Dr had to take biopsies from the lung, and whilst this sounds incredibly stupid, i honestly had no clue how they managed to do that, until i finally saw it being performed! A very very thin wire with a "clamp" at the end is inserted in a separate tunnel attached to the bronchoscope, and comes out the other end adjacent to the camera. The assisting nurse then opens the clamp as the Dr positions it, and closes the clamp upon the Dr's instruction, grabbing onto a bit of the bronchiole, before a sharp yank is applied to remove the specimen. This was almost always followed with some bleeding, but that's a common side effect of bronchoscopy.

Goodbye Cardiology Firm

So that was my cardiology firm over, and my respiratory firm starts on Tuesday!

(no no.. i don't have Monday off, it's just GP placement day... NOTE TO SELF: bring a sandwich)

I think being in London, the ward was always hectic, and i managed to see a lot of different pathologies, and had the opportunity to take several pain histories from patients presenting with myocardial infarctions, or an acute coronary syndrome of sort.

This was great for learning how to take a pain history!! However, in the past 4 weeks, i've not taken a single blood or done a single cannula, and not had an observed cardiology exam done, simply because the doctors are too busy, and there's simply too many of us on the ward... there's:

6 x 3rd years

2 x 5th years

2 x work experience students

... and by the time the 5th week had come round, only 4 students got observed doing a cardiovascular exam on one of the bedside teaching sessions.

I wouldn't say i'm dissapointed at all, because being in London, i knew the doctor's had a busy job to do, and in terms of learning pathology and history taking wise..this has been great!!

Simply put... you get out as much as you put in, and to be honest with myself, i've turned incredibly lazy since coming back to London.. hopefully respiratory firm will be more hands on ^^

To end the firm we had a mini quiz (good bit of emq practice) and that was it... good bye Cardiology....

Hello Respiratory medicine!

Microwave

This post isn't very interesting.. its basically about how i managed to get my chilli con carne microwaved!!

====================================================

Medsoc this term has been quite uneventful.

On my last GP placement, i would interview all the patients coming in to the Dr's clinic, and do quite a few random jobs and examinations... but at the current GP placement i've only seen 2 patients in the 2 visits, examined them both, and didn't get to take a history from either patient...Instead i've been instructed to prepare a 30minute odd presentation on a different topic each time....

GP placements can be so hit and miss!

That aside, this post is titled microwave, simply because my gp placement lacks one. Last week, the snow was still pretty thick, and being a bunch of 4 rather goofy medical students, we all thought it would be a good idea to go out to the town centre and buy microwave meals so we can have a warm lunch that day. It was a mission to make it back out to town (technically my gp placement falls under Essex, and it's pretty green .. and empty out where i;ve been placed!) but alas, we managed to brave it out and back without slipping and breaking any bones..to find that the practice has a dishwasher, and an instant hot water boiler thingy-mabob attached to the wall, but no microwave!

1 student gave up and settled for cafeteria food, but the 3 of us still hungry, and not willing to settle for sandwiches... we walked to hospital next to the practice, and asked the receptionist if there was anyway we could possibly borrow a microwave!

We were directed to the sister's office in outpatients. I knocked on the door politely, and asked the sister if there was anyway, we could please please please use the microwave in the staff room so we could eat our lunches... and she said yes.. on one condition.. "it better not be really strong smelling food like curries and stuff.. what do you guys have?"

1 x prawn biriyani

1 x chicken korma and rice

1 x chilli con carne

............................... she let us use it anyway.... and we were fed!

...............and that's probably the best bit of my new gp placement so far.

Cardiac Surgery: Triple bypass

Last Friday i had one of those moments where i honestly felt truly privileged to be a medical student, as i was given the opportunity to stoop over the operating table and watch a triple bypass being performed.

I've clerked so many patients with CABGs (Coronary artery bypass grafts) and valve replacements before, but i never really thought about the process of having it done, and seeing the sternum cut down the middle with a saw, the ribs retracted backwards, and the heart pumping in the surgeons hands... I'm definitely going to appreciate what goes into a CABG!!

Whilst Mr S. (the consultant) and his registrars were dealing with isolating the LIMA and the heart itself, others were at the legs isolating the veins. This was one of those "team work moments", and what was 5 hours standing at the head of the patient, felt more like 2 hours. I was just so fascinated by how resilient the body was.

I'm not sure when i started thinking this, but i always thought the heart and the lungs were quite delicate, but this was obviously not so true, as the doctor brushed things aside, and rotated the heart in his hands, sticking bits of "towels" (i have no clue what the technical name would be) around the heart to get it into the right position and to clear up whatever blood spilled over.

The surgery had no complications and as fresh i was coming into the theatre in the morning, i left that afternoon with a new appreciation for CABGs. The next time i come across a patient with a CABG, i will definitely think about the pain the patient must have gone through post-surgery.

--------------------------------------------------------------------------

Only 1.5 weeks left on my Cardiology firm! - and i feel like i havn't learnt enough cardiology yet!!

Viva, SBAs and some pharmacology end of firm exam next thursday...

and i have no idea how to revise for it.. i don't even think i can... meh.

--------------------------------------------------------------------------

Random fact.. but i've heard on the rumour mill, that dissection is now going to be made a core component of the medical course at Barts! I'm JEALOUS! Why are they only implementing this the year after i finish my pre-clinical medicine :(