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Showing posts from February, 2018

ER Diaries : Managing First Arrhythmia

Hey people The case was amazing. It must be a normal presentation for SVT but the first time I got to manage. Around 60/F kco HTn on treatment came with complains of chest discomfort  since morning associated with palpitations , blurring of vision , headache .  I thought MI first . Asked her to repeat the history and tried asking her chest pain hai Kya . She still insisted its chest discomfort . I asked the staff for BP and ECG . While I connected her to the monitor .  The heart rate was 210 ! Spo2 was 93. Ecg showed SVT pattern . BP was not recordable . Shifted her to priority area . Connected fluid ( later realised that it was unnecessary ). Sent the ecg to cardiologist . He came down. We were doing vagal manoeuvre and adenosine. He came n told to give 100 J synchronised shock . ( tab yaad aaya ! Arey warning signs🤦‍♀️ shock directly) sedated gave shock. She said aah 😅. (sedation didnt act even after 2 min I guess ). ACLS guides you to sedate but doesn’t teach you t

ER Diaries : Why Emergency Medicine

Hey all! The most impatient Doctor speaking up! Confessing ! Why Emergency Medicine ? For a person who wants hand on everything , a person who can’t choose a best friend among a group of friends , a person who can’t pick a favourite cuisine instead wishes to have it all!  I just couldn’t have asked for a better place. I love dynamic things! I love the way things in emergency come to conclusion , like you treat / stabilise / just send him home ( live / dead ). I love the way the heart restarts for every shot of adrenaline! I love the way the Glasgow Coma Scale improves . I love the way entire team works endlessly turn by turn to resuscitate . I like going h ome tired , unaware of the surroundings , only to hit the sac. People often asked me which specialty you liked the most ... medicine / surgery / gynaecology ? I would respond all of them but only on the duty days (Emergency Days). I hated the way physicians wait for weeks together for medic

ER Diaries : Emergency Medicine

Emergency medicine plays the most important part in caring for the acutely ill and injured patients. Also it is surrounded by so much drama, tragedy, and media interest The department and specialty are a rich subject for debates and criticism . The initial assessment and early treatment in resuscitation, trauma, medical and paediatric emergency will remain the “core” role of the ER physician. What will be the changes to our specialty in the next 10–15 years? Demands will continue to increase. There will be more patients, with more serious illness and higher expectations. There is an emerging vacuum in acute care and it is for our specialty to choose paths to develop. We should start to identify some specific gaps in training and perhaps to restructure training programmes to ensure the necessary skills are obtained. So far so much

ER Diaries : Falling sick

Hey all It's when you're sick you realise , you are important . The one who needs your attention the most is yourself.There were days when I thought about career , people but now I only think about the body I plan to live in till the end of my life.  It’s then when you realise you need your time , you want the time to slow down a bit so that you can heal your tired body. It’s then you realise you need care and attention from your loved ones. You know it’s viral fever , you know it will have its own course , you know it’s benign ... still you seek some empathy and attention. That’s human . That’s us . So far so much

ERDiaries :Festive Casualties

ERDiaries : Day 5 : Festive Casualties : Sankranti  Monday marks a start of new week . You go happily. The scene outside ER is chilled. Lovely weather . But ER as usual was messed up. There were a couple of people enquiring about the insurance claims . (Basically , people you want to throw out of ER.) The mess was post a mass casualty where about 8-10 people were badly injured to the level that their limbs had to be amputated. This was a road accident where a minibus turned upside down. The people where probably returning from their vacation and they obviously didn’t see this coming. 8 year old boy who was playing with manjha got a tear extending from angle of his mouth to the middle of his cheek bilaterally.  25 year old came with a cut on his neck again because of manjha. Poor guy was riding his motorcycle when the manjha came and cut through the skin on his neck . Though not deep , it was definitely not called for as he was not flying kites himself. Don’t panic

ER Diaries : The Crepitus

Hey all 9pm . Chill ER . A 53 year old male Diabetic ,CAD , Stage 4 CKD on hemodialysis who had 2 fingers amputated earlier came complains of swollen lower limbs with non healing wound which developed gradually following rupture of a bleb. The last serum creatinine was 5 mg/dl. On local examination , the wound was foul smelling with pus oozing out.  We examined the wound and called up the consultant surgeon to come and have a look. He walked in examined the wound advised color Doppler of lower limbs . Nephrology referral and was about to leave when a 35 year old lady bumped into him. Who is she? He asked.  Umm... Sir , I don’t know who she is sir . I didnot take her history yet. Let me see . He turned back. A wooden stool had apparently fallen on her trunk leaving the right side of her chest wall in pain.  There were no external injuries. The area was tender . The only complain she had was pain. She was hemodynamically stable n coherent with her surroundings. 

ERDiaries : Kalma Parh Dijiye !

Madam , Aap unke kaan me Kalma Parh Dijiye , Please ! - a young man requested me , even before I stepped into the ER . I had no clue what he was talking about , who he was.  At the entrance itself I see the entire ER team trying to resuscitate a lady .  After about 13 months I saw a collapsed human. I was not scared but puzzled . I placed my bag . Stood there clueless. The team was handling it like a pro and I had no idea how to contribute .  The head nurse enquired who I was . We didn’t happen to meet on my Day 1 in ER. The Resident Doctor  Dr. Waheeja ? ( Name Killed. It’s ok . Quite used to it .)  Yes sir . Done with BLS class.  Yes sir . I said hesitantly ( 9 months ago.)  He asked me to join the team . The nursing team gave me a death stare after seeing my CPR attempts . It seemed like a massage . I don’t know what went wrong with my muscle power . My attempts were nothing close to How CPR is done . I tried to threaten my brain . Brush down my anxie