Last week of medicine

This week is the last week of the Gen Med rotation. What on earth have I learnt? Not much. Well, compared to the ward interns, my job scope does not allow for many learning opportunities since the nature of it is fast-paced.

But I have learnt some things, of course.  If they're right or wrong or the best practice, I am unsure as I have only picked up the habits of my senior doctors.

I am confident how to manage hypoglycaemia (low blood sugar). The first time it happened the consultant was there. The patient had altered conscious state (GCS 10). Checked her blood sugar and it was 1.2! We gave the patient 25ml of 50% dextrose and she improved immediately!

So the next time another patient had hypoglycaemia, I knew what to do. The nurse came running and said the patient (another person)'s blood glucose is 1.9! The patient looked fine actually; but he is a Type 1 diabetic so they're a bit more tolerant to hypoglycaemia. Gave him the same regiment and he too improved immediately.

I know how to manage uncontrolled high blood pressure. Slap on a GTN patch and stat dose of amlodipine.

I know how to do a falls review too. Yada yada yada.

I'm getting there with pain management. This is quite difficult to do because lots of patient that come through the hospital have complex pain issues. Notably:
- paracetamol overdoses (panadol and NSAIDs are out of the picture now that we have to save the liver)
- opiate addiction (haiiya makcik tua umur 65 tahun addicted to morphine and complains of pain...what to do?)
- heroin addicts usually on methadone
- chronic pain which is sometimes more psychological- I will write about this later

The most difficult case I had about pain management was this patient who kept complaining of 10/10 pain (allegedly very severe). She was allergic to panadol (yikes!?), tramadol and voltaren. I kept giving her morphine and its derivatives. Still 10/10 pain. Highly suspicious to me. She didn't look like she was in pain; moving about quite well, not wincing or crying. But therein lies the trouble... you can't tell if the patient is really in pain or merely faking it to gain attention or more drugs. She really gave me a headache.

I am still terrible at reading ECGs. As long as it's regular rate, no t-wave inversion and no ST-elevation I am happy. Right bundle branch block etc2...sorry lerr makcik tak reti.

Next week I start my surgical rotations. I hope it will be a nice change. I definitely need a break from all these overdose patients. I'm so sick of them. There are at least 3-5 every week. I think all the doctors training here can be expert toxicologists by the time we're done!