Lmst

https://emergencymedicinecases.com/anaphylaxis-anaphylactic-shock/#

Kounis syndrome and more about #anaphylaxis

#FOAMed #FOAMcc #emergencymedicine #emergencydepartment #emergencyphysician

Part 1 – Life As A Peri Medical House Officer In Hospital Umum Sarawak | The Emergency Department

Related Posts:

Upon entering the Medical Posting, I was stationed into the “Peri-Medical Pool”. My “birthplace”, so-called.

Prior to entering the Medical Posting, many of my colleagues commented that the Peri-Medical pool is probably one of the worst place to enter considering that it is rather hectic, busy and messy, not to mention the joblist is never ending.

The working shift for a Medical House Officer is as such:

Short Day (SD): 7am till 6pm
Long Day (LD): 7am till 10pm
Night Shift (ON): 8pm till 9am

The Emergency Department in Hospital Umum Sarawak is rather huge and consists of:

Green Zone
EDAU
CSSD
Yellow Zone
Yellow Respi Zone
Green Yellow Zone
Red Zone I
Res Zone II
Decon

Usually a House Officer is allocated to take care of more than one zones.

For example:

Green Zone / EDAY / CSSD
Yellow Zone / Green Yellow Zone
Red Zone I / Red Zone II / Yellow Respi Zone

When the amount of manpower is high, the job gets done quickly and keeping track of the patients is easier.

However, in days where we are stretched thin it is rather difficult.

The Day Shift

Photo by Laura James on Pexels.com

Since I entered the Peri Medical Pool on my Day 1 of tagging in the Medical Posting, my working hours were from 7am till 10pm every day till I offtagged.

I begin my day by first tracing the casenotes of the patients in the zone I am allocated to, snap pictures of the chest x-rays, any relevant radiological reports as well as to trace their bloods.

If bloods were not taken or not in the system, we would then proceed to “summon” the post-night team for help with their bloods.

After all the patients have been traced and the Google Lists have been updated (this is to aid us during our rounds as well as following up on their location later, to ensure that they are not being missed), then I would proceed with my morning reviews.

The morning reviews are just as usual as any morning ward reviews, rounds with the Medical Officer and Specialists and finally carrying out any active joblists.

Since we are in the emergency department, there is usually no afternoon reviews. It depends on the medical officer. Most of the time, rounds are just once daily.

After we are done with our morning joblists, we have to actively screen through the patients in our allocated zones as there is constant movement of the patients in both in and out of the emergency department.

Thus, this means assisting the current on-call team for the day with any STAT bloods or STAT radiological requests as well as updating their progress.

On most days, it is manageable despite the chaos. However, on days where we are lacking in manpower, the difficulty sets in.

The Night Shift

Photo by Photo By: Kaboompics.com on Pexels.com

The night shift begins at 8pm till 9am the following day or until we are done with our “summons”.

I was blessed enough to have gone through perimedical with a partner. Thus, there were two House Officers allocated for the night shift.

As night House Officers in Peri-Medical. We are expected to continue screening through all the casenotes for any new joblist or patients in all the zones in the Emergency Department as well as to assist in any procedures, take STAT bloods or request STAT radiological procedures.

In addition to that, we also have to cover the main building and the side building. This means, if there are any medical patients lodging in non-medical wards, we are in charge of them as well. Most of the time, it is just new transfer ins, sometimes, it is attending to any acute issues.

This is then followed by taking the “coming mornings” or bloods of the stranded patients in the Emergency Department of the lodging patients.

The amount of patients in the Medical Department is extremely high and thus, the medical patients can be stranded up to days in the Emergency Department which can even last till they are being discharged.

Thus, this ensures that the patients are being continued on their treatment irregardless of their location within the hospital.

The night shift as a perimedical house officer can get rather hectic if there are back-to-back influx of new patients in the Emergency Department, tons of coming mornings as well as acute issues in the ward.

In the morning, the “summoned” list can get rather extensive and chaotic as well and can be rather endless.

Hence, on top of the constant walking about the whole hospital, it can get rather tiring. But like I said, it is doable and manageable.

In fact, I enjoyed life as a perimedical house officer a lot.

If you are due to join Peri-Medical, fret not. Keep yourselves equipped with necessary forms and just work quick and as fast as you can.

On some days, one might get lost in the sea of chaos. However, stay strong and know that help is always within reach and that you are not alone.

About Me | Privacy Policy | Contact Me

#article #Articles #Blog #blogging #bloggingAsADoctor #dailyblog #dailyprompt #dailyprompt1804 #dailyprompt1813 #dailyprompt1834 #dailyprompt1836 #dailyprompt1838 #dailyprompt1841 #dailyprompt1844 #dailyprompt1853 #dailyprompt1855 #dailyprompt1857 #dailyprompt1858 #dailyprompt1860 #dailyprompt1959 #dailyprompt1962 #dailyprompt1971 #doctor #emergencyDepartment #hospital #hospitalUmumSarawak #houseOfficer #housemanship #kuching #medical #medicalOfficer #Medicine #periMedical #sarawak #sarawakGeneralHospital #writing

https://first10em.com/research-roundup-for-april-2025/

#CriticalCare done well
#FOAMed #FOAMcc #emergencydepartment #emergencyphysician

https://first10em.com/pediatric-front-of-neck-access/

One of the scariest situations and probably the less evidence-based procedure in #emergencydepartment and #CriticalCare

The Pediatric FONA

#FOAMcc #FOAMed #FoamEm #emergencymedicine

https://first10em.com/the-first10em-monthly-wrap-up-for-winter-2025/

#FOAMed community should quit twitter
#FOAMcc #emergencydepartment #emergencydoctors #emergencymedicine

NHS Greater Glasgow & Clyde Emergency Department Review: March 2025
https://www.healthcareimprovementscotland.scot/publications/nhs-greater-glasgow-amp-clyde-emergency-department-review-may-2024/

#Health #Scotland #Hospital #Glasgow #EmergencyDepartment

My First Day In Medical Posting – Tagging Day 1 | Housemanship Diaries

Tell us about your first day at something — school, work, as a parent, etc.

Related Posts:

Finally, my much awaited posting… Medical!

Ever since I was a first poster, I have always looked forward towards the Medical Posting but one I decided to keep as my last as I wanted to “learn“ and understand the posting rather than just “float” through.

This served as a disadvantage in other postings as when it came to simple management of hyperkalemia or hypokalemia, I wouldn’t know, neither hypoglycaemia or hyperglycaemia.

Instead, I simply memorised my way in terms of the simple management and “referred to Medical” rather than actually learning to correct them myself in other postings.

Thus, I went complex and complicated first prior to building my way up.

My first day in this much awaited posting was on the 11th of December 2024. I had just completed the Surgical Posting and was on a 5-days-break.

On my first day, I was allocated into the “Perimedical Pool”. Deemed as probably the “worst place” to be allocated in. Thus, as usual, the fear starts creeping in.

I started asking around in regards to my job scope as well as the superiors.

Most of them advised to just arrive on time, which I did, at 7am sharp.

That morning, I was allocated to handle the “Yellow Respi” zone of the Emergency Department.

Thankfully, I had a good friend who was my partner for the day.

We began with tracing x-rays of the patients as well as their blood investigations.

After we have gone through all of the patients, we began with our morning reviews while awaiting our medical officer and specialist.

The medical officer arrived and started reviewing the patients with my friend. Here I was, on Day 1, extremely blur.

I introduced myself to the medical officer and he proceeded to tell me to go about my own reviews while he assessed the other patients with my friend.

Alright, here we go again, just like in every posting. Just how and what am I going to review?

Soon, the specialist came and I proceeded to follow the rounds as I was used to in the Surgical Posting where we all followed the grand rounds.

Instead, I was again asked to proceed with reviewing the other patients in the other cubicle while they go about their rounds.

Feeling quite lost and left out, I proceeded as such. Before I knew it, I reviewed all the patients in that particular cubicle just in time when the medical officer and the specialist came.

Thus, I started presenting and writing, still being tuned to the work culture in the Surgical Posting.

Just like rounds in the other postings, we presented, followed, write and after rounds, proceeded with discharges and carrying out the active joblists.

Surprisingly, I had time for lunch.

Afternoon rounds started at 2pm with just the medical officer and my superior was more than kind enough to start explaining and teaching me as to why certain things are as such.

After the PM rounds, I proceeded to screen through the casenotes and update the list of patients in my zone as well as to take any STAT bloods. Before 6pm, I went for my early dinner.

Considering I was tagging, I had to stay till 10pm whereas the rest who are “Short Day” or “SD” went home by 6pm. Thus, from 6pm till 10pm, I was actively screening through the casenotes in the Yellow Zone, Yellow Respi Zone, Red Zone, Red Zone 2, CSSD, EDOU, Green Yellow Zone and updating the list as well as to take any needed STAT bloods which mainly included blood cultures.

A little before 10pm, I approached one of the medical officers to get my signature for the day and went home.

That concludes my first day of tagging in the Medical Posting which surprisingly turned out rather well. For the first day at least.

About Me | Privacy Policy | Contact Me

#article #Articles #Blog #blogging #bloggingAsADoctor #dailyBlog #dailyprompt #dailyprompt1804 #dailyprompt1829 #dailyprompt1838 #dailyprompt1843 #dailyprompt1852 #dailyprompt1858 #dailyprompt1860 #dailyprompt1861 #dailyprompt1862 #dailyprompt1949 #dailyprompt1979 #dailyprompt2151 #doctor #emergencyDepartment #firstDay #hospital #hospitalUmumSarawak #houseOfficer #housemanship #internship #kuching #Malaysia #medical #medicalOfficer #perimedical #sarawakGeneralHospital #tagging #writing

https://youtube.com/watch?v=jFz1WN8LY9A&si=L0ay3YoGmzoi8rTA

Good #personal definition of #status epilepticus #FOAMed #FoamEm #emergencymedicine #emergencydepartment #FOAMcc

Entrance to Wexner Medical Center’s emergency department temporarily relocated due to construction - Davis Beatty

My First Day Back At Work After A 6-Week-Break | Housemanship Diaries

Related Posts:

I officially returned to work on the 2nd of October 2024.

Initially, I was stationed to work the morning shift at ward. However, a colleague of mine decided to take a sick leave on that day when she was initially stationed as the House Officer in the Emergency Department, ETD HO.

Being the Allocation Leader in this department, it is my duty to immediately look for a replacement and to update in the group with the medical officers. Not one person came to mind and I felt bad since it was a friend of mine who took a sick leave or did I feel comfortable dragging another person to cover this shift since it is a shift most people avoided.

Thus, I offered to be the ETD HO myself. It was during an anaemic House Officer period and there were only one House Officer stationed at the Emergency Department.

Hence, I went to work and stocked up my necessary supplies before meeting the post night House Officer in the Emergency Department to receive my handover.

Of all days, it had to be one whereby no coming mornings (bloods) were taken for the patients and there were a lot of active job-lists not being carried out. Not to mention scans to be requested the following morning.

Basically, there were a ton of “shits” being thrown to me and if I do not settle it myself or to push my post night colleague to help me, I would be in a mess for the day.

Imagine having just returned to work to this. Without thinking much, I started identifying the patients who had bloods to be taken and proceeded to take all of them and sent it off. After sending them off, I started preparing for scans and called the radiology medical officer oncall to present my case.

Finally, after I thought I was done, I decided to review the stranded patients.

Normally, the stranded patients should be reviewed around 7am as we would begin our morning rounds around 7:30am till 8am. Thankfully, it was the weekend and rounds began much later.

I went through my list of stranded patients and there were almost 20. 20 stranded patients at various locations.

Would I have the time to review all of them? What about the active joblists or scans? Can I rely on my post night colleague? What if there is a new case?

I remembered it being a rainy day and the referrals were initially from wards and not from the Emergency Department (ETD).

Perhaps it would be a slow day. I thought to myself.

But, I thought too soon.

Soon, referrals started piling up. My medical officer’s phone (MO) was blowing up with calls. Other sub-specialities kept reaching out for me to help them out and at one point, me and my medical officer had to split to ensure we got everything done to the best that we could.

I wished that I could literally divide myself but I couldn’t. On top of that, my right foot started to ache. I just came back from a 6-week-break. I can’t afford to go on anther few weeks. If I do, just when am I going to end this posting?

I recalled it being a terribly hectic day and I felt bad as I was mostly away, having been dragged away by other sub-specialities, escorting patients or carrying out the active job-lists. I could not really be by my medical officer’s (MO) side to see the cases.

Finally, the end of my shift approached. 7pm and my night colleague came for handover.

Despite it being the evening already, the fire was still burning strong, referrals did not stop coming in and I still had tasks to complete or I would be handing over “shits” to my night colleague.

Finally, it was around 8-9pm, I can’t really remember as I was following night rounds with the OT call medical officer and registrar. My medical officer told me to return home since the following day, I would be morning shift.

I remembered returning home that day, somewhat unsatisfied with myself. No doubt that it was a tough day, but I could definitely do better. If only my leg did not slow me. The pain seems to increase with every step I took and with every exertion I made.

However, as I remembered, I was blessed to have an angel as my medical officer oncall for that day. Instead of shaming me or being sarcastic or mentioning that I could do better, she simply thanked me for putting my best effort on the first day back and welcomed me back.

It’s angels like this who makes me want to try to be better the following day.

About Me | Privacy Policy | Contact Me

#article #Blog #blogging #dailyprompt #dailyprompt1804 #dailyprompt1834 #dailyprompt1897 #dailyprompt1905 #dailyprompt1910 #dailyprompt1911 #dailyprompt1971 #dailyprompt1977 #dailyprompt1981 #dailyprompt1982 #dailyprompt1983 #dailyprompt1984 #dailyprompt1985 #dailyprompt1986 #dailyprompt1993 #doctor #emergencyDepartment #hospital #hospitalUmumSarawak #houseOfficer #housemanship #Malaysia #medical #medicalOfficer #Medicine #sarawakGeneralHospital #surgery #surgical #work #write #writing

Health workers brace for the worst as psychiatrists across NSW resign: With more than half of the state's staff specialist psychiatrists set to resign by the end of the week, health workers say the impacts will reverberate throughout the healthcare system, including already-stressed emergency departments. https://www.abc.net.au/news/2025-01-29/emergency-departments-nsw-fallout-psychiatrist-resignations/104844112?utm_source=dlvr.it&utm_medium=mastodon #NSW #emergencydepartment #psychiatristresignation

Emergency wait times blow out as hospitals struggle to discharge patients: The amount of time Australians are waiting in hospital emergency departments is increasing with the average wait time for admission now between 12 and 16 hours, according to a new report. https://www.abc.net.au/news/2025-01-17/emergency-department-wait-times-blowout-hospital-health/104815792?utm_source=dlvr.it&utm_medium=mastodon #emergencyroom #emergencydepartment #ED

#VideoLaryngoscopy Improves Success Rate of Emergency Tracheal Intubation https://www.medscape.com/viewarticle/video-laryngoscopy-improves-success-rate-emergency-tracheal-2024a1000j95

#EmergencyIntubation #AirwayManagement #CriticalCare #EmergencyMedicine #PatientSafety #IntubationTechniques #MedicalTechnology #AnesthesiologyAdvances #EmergencyAirway #IntubationSuccess #ClinicalTrials #MedicalResearch #EmergencyDepartment

Norhtern Ont. ER to close over Christmas
North Shore Health Network has announced another emergency department closure over the holidays – once again at its Thessalon site.
#closure #holidays #emergencydepartment #Thessalon #NorthShore
https://northernontario.ctvnews.ca/video?clipId=3052403

https://first10em.com/big-practice-change-coming-how-fast-do-you-correct-hyponatremia/

#FOAMed #FOAMEDcc #FOAMcc #emergencydepartment #emergencymedicine

Recent Interventions for Acute Suicidality Delivered in the Emergency Department: A Scoping Review (Hood, et al, 2024) https://pubmed.ncbi.nlm.nih.gov/39625755/ #ketamine #psychedelic #psychedelics #suicidality #emergencydepartment

https://pubmed.ncbi.nlm.nih.gov/39564631/ Acute severe pain in emergency department: Morphine or low-dose ketamine? #ketamine #pain #EmergencyDepartment Fun fact: Low dose ketamine may have psychedelic effects as profound as other psychedelic medicines, compounds and plants, also being studied for pain. #psychedelic #psychedelics #psychedelicassistedtherapy #ketamineassistedtherapy #ketaminetherapy A psychedelic therapist can prepare and debrief someone being treated in this approach. #mentalhealth #mindbody

Been waiting at the 2nd emergency department for 2.5 hours.

Looks like a de facto diagnosis of "nothing urgent happening" has been made. Patient has paid $300 for this privilege.
They're getting tired and hungry and are still breathing, conscious and having the spasms.

Looking suspiciously like large hiccup movements.

Folk argue about #ModernMedicine.
I'm more interested in looking at #CommercialisedMedicine.

#EmergencyDepartment #ED #DoingItDifferentThisTime

Just walked out of one ED without receiving care.

Longest wait time there was 7 hours.

I'm caring for the person seeking care.

1. I'm paying for parking.
2. The seat I was assigned to has a hand sanitiser unit where my head wants to sit.

No problem with me if the #WesternAustralia #MinisterForHealth #JadeSanderson is subjected to these conditions on a daily basis.

#EmergencyDepartment #ED #DoingItDifferentThisTime

In at Emergency, an elderly relative is having spasm/convulsions (not medical term) a bit like a whole torso hiccup.

#EmergencyDepartment #ED #DoingItDifferentThisTime

#EmergencyDepartment

Client Info