Day 7 of 20
Belated entry - fell asleep after the ambulance run!
Not very eventful, but at least I saw a drug overdose case. Well in chronological order:
1) At 9pm, the siren sounded - a very confused medical student (moi) didn't know that was the Let's Go! signal until SSG Maddy filled me in on that. Turned out to be a near-syncope or fainting case, I don't really know since by the time we reached there, the man was kinda conscious, GCS 14 (E4 V4 M5) and lying on a makeshift stretcher. History was, he actually went to the public toilet near a market to pee, and kabonked. The over-enthusiastic toilet attendant was so garulous, he literally talked non-stop all the way till the patient was loaded into the ambulance! They did a hypocount for him before loading him, and he was a known DM who claimed he took 1 glass of beer (questionable - he was absolutely reeking of alcohol actually).
Met Alvin Ang's gang when we arrived in hospital.
2) Somewhere around midnight we ran off to Jurong for a fall case - at first, I got really excited. I thought it was a fall from height! Gah .. turned out to be a DO case, he got groggy and fell down. A passerby called 995 and disappeared from the scene. Man admitted to being PSY case, been at IMH and given amitryptylline. He took 16 tabs of that; before that, he took 8 panadols within 1 hour, supposedly due to a right flank pain. Past medical history of prolapsed intervertebral disc, but on the alpha he didn't exhibit a positive sciatic stretch test (impressive maneuvre by the lady paramedic!) Also, some tenderness around the epigastrium with no guarding. ECG was normal.
Had a mini-tutorial by the lovely ER doc at NUH on DOs, and we were commenting on why the IMH doc gave him amitrypt. when this man actually had a past Hx of DO. SSRIs should have been given, according to our dear pharmacology books. I was so engrossed in talking with the doc that I think I delayed the poor paramedics by 2-3 minutes, ooooooops. Too bad I couldn't stay to watch the gastric lavage!
3) One of those DUH! cases that the paramedics complained to me about. Young lady (NUS student actually, lol ... PRC) complained of severe epigastric pain, with past Hx of gastritis 2 years ago. Gah ....... why would anyone want to call for an ambulance for this when they can jolly well take the lift to take a cab? Hmm .. perhaps they thought that 995 was a free service. AHA. Wait till they get their $100+ ambulance bill. =D
The paramedics are really a very, very fine bunch. Most impressive was the lady staff sergeant, who was quite pretty but a little too gung ho ... they really liked having med students on board, I could tell. And hmmm ... actually made me give them some tutorials? Hahaha ... some of the stuff I was asked:
1) If stroke is usually accompanied by fever
2) Exhibit proper technique of abdominal palpation (they only do 4 quadrants instead of our 9)
3) Differential diagnoses of epigastric pain
4) Proper history-taking of epigastric pain in young women (I was DEEPLY impressed when the SSG asked for last menstrual period! Ectopic pregnancies!!)
Hit off really with especially with the NSman medic, we really talked a lot through the night. It was disappointing that there were only 3 cases though. And the night was awfully dreary. I declined to be given a bed to sleep on (which would mean that one poor man would have to kip on the floor; I really couldn't have that on my conscience, those people do this for a living!) so I ended up reading the E Med text half the night and trying desperately to sleep on the desk top after 4am, and ended up with severe contact dermatitis.
Also stayed behind to watch their morning drills! It's actually the firemen's drills that were interesting ... the paramedics just stood there with their trolley and the SSG was giving her trainee a tutorial on IV line insertion. Then they wheeled it away, and I was like, "huh?" .. well ... that was their "drill". Anyway, the NSman and I had a jolly good time gossipping about the station's OC. =D Was treated to cup noodles by the boss (SSG Maddy), how nice! Apparently the others also benefitted from my presence; they were absolutely thrilled that "boss" was treating everyone. Slightly guilty though - I had some food with me, but not enough to share with everyone, so I didn't eat them in the end.
Mom was an absolute brick!! I was going to do something dreadful to myself like stuffing my whatever into the fire hose for forgetting to bring my emed text!! So I was actually stuck with OSCE's in surgery and the chest xray book which I always carry around in my car. Called mom, asked if she's passing by, and yay! I had the book to read! =D
It was a nice experience, but no thanks .. I don't think I'd want another night shift.
Not very eventful, but at least I saw a drug overdose case. Well in chronological order:
1) At 9pm, the siren sounded - a very confused medical student (moi) didn't know that was the Let's Go! signal until SSG Maddy filled me in on that. Turned out to be a near-syncope or fainting case, I don't really know since by the time we reached there, the man was kinda conscious, GCS 14 (E4 V4 M5) and lying on a makeshift stretcher. History was, he actually went to the public toilet near a market to pee, and kabonked. The over-enthusiastic toilet attendant was so garulous, he literally talked non-stop all the way till the patient was loaded into the ambulance! They did a hypocount for him before loading him, and he was a known DM who claimed he took 1 glass of beer (questionable - he was absolutely reeking of alcohol actually).
Met Alvin Ang's gang when we arrived in hospital.
2) Somewhere around midnight we ran off to Jurong for a fall case - at first, I got really excited. I thought it was a fall from height! Gah .. turned out to be a DO case, he got groggy and fell down. A passerby called 995 and disappeared from the scene. Man admitted to being PSY case, been at IMH and given amitryptylline. He took 16 tabs of that; before that, he took 8 panadols within 1 hour, supposedly due to a right flank pain. Past medical history of prolapsed intervertebral disc, but on the alpha he didn't exhibit a positive sciatic stretch test (impressive maneuvre by the lady paramedic!) Also, some tenderness around the epigastrium with no guarding. ECG was normal.
Had a mini-tutorial by the lovely ER doc at NUH on DOs, and we were commenting on why the IMH doc gave him amitrypt. when this man actually had a past Hx of DO. SSRIs should have been given, according to our dear pharmacology books. I was so engrossed in talking with the doc that I think I delayed the poor paramedics by 2-3 minutes, ooooooops. Too bad I couldn't stay to watch the gastric lavage!
3) One of those DUH! cases that the paramedics complained to me about. Young lady (NUS student actually, lol ... PRC) complained of severe epigastric pain, with past Hx of gastritis 2 years ago. Gah ....... why would anyone want to call for an ambulance for this when they can jolly well take the lift to take a cab? Hmm .. perhaps they thought that 995 was a free service. AHA. Wait till they get their $100+ ambulance bill. =D
The paramedics are really a very, very fine bunch. Most impressive was the lady staff sergeant, who was quite pretty but a little too gung ho ... they really liked having med students on board, I could tell. And hmmm ... actually made me give them some tutorials? Hahaha ... some of the stuff I was asked:
1) If stroke is usually accompanied by fever
2) Exhibit proper technique of abdominal palpation (they only do 4 quadrants instead of our 9)
3) Differential diagnoses of epigastric pain
4) Proper history-taking of epigastric pain in young women (I was DEEPLY impressed when the SSG asked for last menstrual period! Ectopic pregnancies!!)
Hit off really with especially with the NSman medic, we really talked a lot through the night. It was disappointing that there were only 3 cases though. And the night was awfully dreary. I declined to be given a bed to sleep on (which would mean that one poor man would have to kip on the floor; I really couldn't have that on my conscience, those people do this for a living!) so I ended up reading the E Med text half the night and trying desperately to sleep on the desk top after 4am, and ended up with severe contact dermatitis.
Also stayed behind to watch their morning drills! It's actually the firemen's drills that were interesting ... the paramedics just stood there with their trolley and the SSG was giving her trainee a tutorial on IV line insertion. Then they wheeled it away, and I was like, "huh?" .. well ... that was their "drill". Anyway, the NSman and I had a jolly good time gossipping about the station's OC. =D Was treated to cup noodles by the boss (SSG Maddy), how nice! Apparently the others also benefitted from my presence; they were absolutely thrilled that "boss" was treating everyone. Slightly guilty though - I had some food with me, but not enough to share with everyone, so I didn't eat them in the end.
Mom was an absolute brick!! I was going to do something dreadful to myself like stuffing my whatever into the fire hose for forgetting to bring my emed text!! So I was actually stuck with OSCE's in surgery and the chest xray book which I always carry around in my car. Called mom, asked if she's passing by, and yay! I had the book to read! =D
It was a nice experience, but no thanks .. I don't think I'd want another night shift.
posted by R. at 3:59 AM
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