neophyte's report

I am flattered that I have been a part of the Trauma team. I have always wanted to work in such area and no regrets at all. Assessment and monitoring of vital signs is the most essential task in all areas.

In the Internal Medicine Department, the most common medical problem I have encountered is hypertension, COPD and loose bowel movement.

It is important to keep in hand a respiratory mask because patients in this area do a lot of coughing and besides, microorganisms are too small to be seen. You do not know what your patients have till they undergo diagnostic procedures.

One patient came in ambulatory and said he just wanted to have his blood pressure checked. So I took his initial blood pressure and referred it to the resident on duty who was sitting adjacent to me and was also interviewing the patient. The moment I turned my back and already around 2 meters away, he collapsed and he had seizure. I was surprised how suddenly a patient who looks so good at first sight, who was conscious and coherent would suddenly loss consciousness. So we had him placed on a stretcher and the doctor started an IV line and gave him medications from our supply. What i am trying to say is that, some patients may look good at first sight but could be masked by a terrible condition. Well, all I can say is that the Emergency Room is full of surprises: from the patient’s condition, to the facilities, to the staff on duty and even to the utility workers.

I got to practice how to take ECG. I also got to appreciate adventitious breath sounds through auscultation. I did a lot of intramuscular pain medication injections (ofcourse with consent). Then I also did cardio-pulmonary resuscitation to a person with only a few seconds to spare. I even tried doing post-mortem care to a patient I never even got to handle. But I am thankful that I never had any patient who went into arrest during my care.

Most patients I met in the Surgery Department were either mauled, had a bad fall or had a vehicular accident. In this area, I got to have an appreciative look at contusions, abrasions, lacerations, broken bones in the xray film, traumatic amputation of fingers, gun shot wounds, dog bites, etc.

Stabilizing the patient in this area is very important from the vital signs down to blood loss. Splinting, wound dressing, bandaging, applying pressure and assisting the patient to move in the ER, preparing the patients during the pre-operation like shaving, changing to OR gowns, checking of pre-op meds, catheterization, NGT insertion etc. are routines done in this area

Most cases I have assisted in this area are suturing. I remember, one time, we had a patient who had a vehicular accident and a had laceration on the foot around 6-7cm that divides the sole of the foot halfway horizontally. Bleeding was controlled by putting pressure and bandaging the wound with a roller bandage. At first sight it did look like a minor surgery, until the xray film revealed that there were fragments of broken bones. And when the resident checked the wound, he discovered that the wound was too deep and that the sole of the foot was flapping open revealing fragment of broken bones. So we referred the patient to an orthopedic doctor and was scheduled for a major operation in the Operating Room.

The worst case I have handled is a referred patient from the province with blast injury that left the patient with ruptured eyes, traumatic amputation of both left and right fingers and with multiple lacerations, abrasions and splinters on the face, upper and lower extremities and on the abdomen. There was a double line IV and the blood pressure of the patient was still difficult to assess. I had to monitor the IV line, the vital signs and the urinary output. When vital signs were stabilized, we had her transported to the ward for continuity of care. She undergo different surgery from eye surgery to amputation to exploration laparotomy. The last time i heard about that patient is that she still died of sepsis.

The challenging part in the OB department is the smell of lochia. But this department is also one of the most flattering areas I have been to. I have assisted in deliveries. And just the sight of the baby makes me feel happy.

On the other hand, it sickens me to see patients who attempted to commit abortion. They are in total denial and I couldn’t determine if they are in shame or they are just apathetic.

Vital signs and weight and height taking are routinely done in the OB unit. Patients were asked to lay on the lithotomy bed and spread their legs for the physician to do an internal examination. I have tried doing internal examination and many times I have felt the head of the baby. We do perineal preparation and we teach the patients to do deep breathing exercises. And many times, I have pushed stretchers with the patient on it to the delivery room.

I have seen the lifeless body of fetuses but I have also seen wonderful beings come to life

The Pediatrics Department is the most challenging part of the Emergency department (even the taking of vital signs is challenging), but I love it! Patience is a virtue in the pediatrics unit. It is the most challenging unit in the Emergency room but the most rewarding.

It is difficult to manage kids especially when you are strangers to them. I can attest how difficult it is to be therapeutic at all times by most health professionals (especially after seeing kids in ill state...grr )

Weight taking aside from temperature, heart rate and respiratory is important in pediatric patients. The dosage of the medication depends on the weight of the patient. So it is routine that we take the weight of the patient as soon as they get to the pediatrics department.

I remember one patient who came to us severely dehydrated and in respiratory distress. I secured the consent for intubation and have assisted in intubation. The doctor had to teach the patient’s relative to do ambubagging. I did continuous ambubagging (very tiring but rewarding task) until the patient was transported to the NICU. I have been with that patient to the xray room and back to the ER. And until the oxygen saturation level shoot up and stabilized to 98%, we had the patient transported to NICU (with me tagging along).

The Emergency Room in my hospital is a complex network. No wonder most patients look disoriented the moment they set foot in the Emergency room. They do not know which area to go to, whether surgery department, IM department, pediatrics department or OB department. First they have to fall in line at the Admitting section for an interview for an Emergency Record. Then they have to go to the Cashier and pay up. Then they can get their record where the physician could fill up his or her assessment. And with the number of patients that gets in the Emergency Room, there is limited space, equipments and manpower to give optimum care. So we prioritize care to the patients in need of immediate medical care or to someone with immediate life threatening condition.

Team work is very important. Two minds are better than one. That is why, we have a lot of referrals to different department for collaborative management.

Moreover, I think it is important for health professionals to learn how to speak different dialects. I had a hard time dealing with people who can’t speak tagalog and English. It was difficult to explain to them the procedures and what is happening.

I met a lot of good working and malfunctioning facilities. We have a stethoscope without its ear piece, an ECG that without strips, a BP apparatus that doesn’t work well and an alcohol breath test using the sense of smell.

Still, above all, I am grateful to be assigned in the Emergency Department though I’ve experienced a lot of stress and weight loss. My assessment skills were sharpened. I have learned to move more quickly and use time management. I have done a lot of stuff, some which I have ignored during my student days and some which I have never encountered before. I can say to my self that I have acquired a lot of knowledge, skills and work values in my area of assignment.