DR. WAJEEHA ISSUES

Hey all! Sometimes I'm amazed by how much I keep learning every day. Little facts, little life hacks, simple lessons to make life easier.  But honestly, the big lessons in life, the most important ones, are those that come with time. The only branch ER rejects is a branch of hemodynamically stable patients. We don’t put our hands off , like other specialities. We see that every body gets what they require in emergencies.  The discussions with consultants remind you of Med school. Things you forgot or things you never learnt. You sweep it all at once! ER - Amazing place to be in ! So far so much!

Late post.Supposed to be posted on April 7. Wedding jewellery can wait . Insurance can’t ! There is nothing more than personal well being. You break one bone of yours and then see how all your savings shed all at once , like alopecia post chemotherapy. So this world health day. As soon as I’m employed my first investment will be my health insurance. Lots to talk about it.  Will do it in subsequent blogs. Bye!

Classic case of Hypocalcemia  42 year old male presented to ER with painful carpal spasm since 30min after consuming alcohol sudden in onset. No ho fever / CP/SOB/ dehydration/ headache/ Kco DM not on medication. Smoker alcoholic Vitals BP 170/100mmHg Grbs 153mgdl Pr 90/min Rr 24/min Spo2 97% on room air Temp 98F Ecg LVH pattern  Examination  Red eyes prolly due to the influence of alcohol Aggressive demeanour  None of the systemic findings came positive except for trousseau sign + Pitting Pedal edema  I quickly sent abg and s calcium. S. cal was 7.8  K was 2.7 Na also on 127ish 10% Calcium gluconate slow Iv Slow Nacl 0.9% Took physician opinion. KCL he asked to start  But then for high concentration electrolyte icu admission required.                                                 They had insurance that didn’t work in our hospital,they refused. Discharge them against medical advice . Explaining them risk of tr

Hey all  First experience for everything. This is the first and last breathe of yours for the day. There is always a first time and a second last chance. Though declaring a person dead is a simple routine, but undoubtedly a critical moment for a doctor, especially when the person dying is your neighbour.  Declaring death is not technically hard but it is weird and sad. It is an organized step-wise process of patient’s examination to assess the brain functions.  I take a day off from work. Refuse an exchange of duty of a co worker. Plan to go out to an amusement park gets popped by momma ,the dearest. I switch to YouTube. Get up. The neighbor aunty called up. Her mother in law is not keeping well.  Yeah . So ? Take your stethescope and Walk! Oh hello , Madam. Not well? LIke what went wrong. Tell me proper history. I didn’t want to go there for chronic backache! Am ERPhysician ! Just come.  Ok mom. Get the

hey People ! Like it or not, charisma matters when it comes to leadership. But we should be aware of the power that persuasion can have on us. Charisma is a force that can rally people Hi during difficult times, but it can also blind people and lead them to accept unwise actions, policies or conditions. And when it comes to leadership, political and professional, charisma matters more than we’d probably like to admit. Emotional suppression absorbs mental resources, deteriorates cognitive performance and impacts memory Keeping ourselves from getting influenced for a charismatic leader is tough.But our task is to remind ourselves that he or she is an ordinary human being. So far so much!

Heyyyya! There was this 60yr old man . Fever  cough and weight loss history  On hemodialysis history I ask him routine questions... Fever  ? Cough   ? Intermittent ? Body pains  ? Chest pain ? difficulty in breathing  ? Urine me jalan hai kya ? N he is like  Madam , main dialysis pe hu... merko urine Nai aata ! I was in this awkward face palm situation blabbering senselessly like a pet parrot! This made me feel like a fool to be honest. I rush home zero down to hemodialysis . Read about it like it’s the last day on the planet and if I don’t read it today. The death angel will take me nowhere but hell! Because the patients on hemodialysis constituted good number of cases reporting tonER in pulmonary edema and altered sensorium. The only thing that would give respite to them was hemodialysis. Rest all was temporary management. Read about how important asking about fistula is !  It’s like a second heart frankly. You don’t touch it . Yo

 Hey all! It’s strange but I find myself in midst of situational comedy most of the time . Here is another funny instance. I examine a patient. Report the findings to my senior to  - Sir , There is a sound net apical lobe. It’s neither a crepitus nor a wheeze. He turned around as asked , what do you think it is? Puzzled , I said , pata nai aisa sound suni nai 😂 kabhi. He asked me to examine again. I did the same . Told the same findings. Are you sure it’s from the lungs? Yes , apical lobe . Sure? He laughed and said. That’s a murmur ! My reaction 🤦‍♀️ What the mind doesn’t know, an ear doesn’t hear.  So far so much

Serious stuff Note: Such incidents are a common thing for people from Day 1 of your housejob. You never know what threat you’d be exposed to. Our condition to be honest is worse than soldiers. Soldiers atleast know that they’d die on war . A bomb is expected at the border or a bullet on field. They die an instant death . We are just unaware! Somebody may just knock your door one fine day stating look my mother is really sick , help me out . It’s an emergency. You roll over your sleeves . Manage the case . Only to find the reports stating positivity to viral markers. Better keep yourself vaccinated to hepatitis B atleast . Hep C and HIV we just can’t help! A similar episode happened . An ERPhysician from another hospital walked in to inform us that he was leading an ambulance. A patient is supposed to arrive. He had done CPR on insistence of the family. He was having his meal when the call for help came. He just had to leave everything and go. His resuscitation attempts faile

hey all! Like a blue moon or eclipse I appear . Tell a tale and disappear . Today’s discussion is about the little dilemma book VS practice. Around 60 year old lady presented to ER in a drowsy state . Alleged h/o consumption of 10 tabs of 0.5 Alprazolam and 10 tabs of 500mg PCM 1.5hr back. No Vomiting / seizure / frothing/ sweating/ palpitation/ or any incontinence . KCO DM HTN CAD Depression Hemodynamically stable Patient drowsy  yet aggressive pupils 2mm RL+ Power 5/5 Lungs clear Abdomen soft B.S.+ MLC was registered Treatment wise  Pantoprazole Ondasetron  And Gastric Lavage was done They had affordability issues , they took the patient away. So the twist of the tale was OHEM says no gastric lavage for Benzodiazepines as it’s not fatal except for elderly and COPD cases . Only supportive management. Since pCM was 5g n she was elderly . ( mixed poisoning) It was not a blunder. But the consultants do gastric lavage for benzodiazepines. What t

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

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

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

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 : 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

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.