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Your first day as a doctor

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Reply 180
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Deema
1
Work from the head down :colone:
AND SHOCK HIM :biggrin:
Reply 181
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dearyme
6
Call my mum to come and pick me up...
I might be able to tell you after 5/6 years! :yes:
Original post by electricjon
An 18 year old female attends
What would you do next?


Give an alternative drug for pain?
Mmm well firstly pain management, titrate morphine-what's she had already? Give her paracetamol, you can have coedine too. Maybe something like a 'heat compress'. HOWEVER case does sound fishy...i'd want to manage pain, could be a more 'fear' of pain she's suffering with. Instinct is saying pain management (without knocking her out and going into resp arrest!) a bit of TLC and discharge tbh...but I'm
not a doctor, but from a nursing perspective it's what I'd do/expect

BUT what was the radiographer doing moving her if she's mobile?!
Reply 185
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electricjon
OP
Original post by Subcutaneous
Mmm well firstly pain management, titrate morphine-what's she had already? Give her paracetamol, you can have coedine too. Maybe something like a 'heat compress'. HOWEVER case does sound fishy...i'd want to manage pain, could be a more 'fear' of pain she's suffering with. Instinct is saying pain management (without knocking her out and going into resp arrest!) a bit of TLC and discharge tbh...but I'm
not a doctor, but from a nursing perspective it's what I'd do/expect

BUT what was the radiographer doing moving her if she's mobile?!


You've given her everything - paracetamol, ibuprofen, codeine, entonox and loads of morphine, and she's still screaming in pain.

You ring the radiographer and ask what happened. He says "I didn't touch her!" - you believe him.
Original post by electricjon
You've given her everything - paracetamol, ibuprofen, codeine, entonox and loads of morphine, and she's still screaming in pain.

You ring the radiographer and ask what happened. He says "I didn't touch her!" - you believe him.

Well as a junior may what a second opinion on xray, possible you missed something...then query why on your first day as an f1 you're not in a lecture theatre getting induction talks lol

Speak to family, get their perspectives and ask her what she makes of the radiographers comment (nicely ofcourse).

What is she rating her pain/the pain assessment? I'd scream munchausens..but that's just first impression.

Oh and maybe fluids up & 2-4l o2 if she's been on a fair whack of morphine to be on the safe side.
Refer her to the radiographer again for a second x-ray incase anything was missed.
Original post by Dekota-XS
Refer her to the radiographer again for a second x-ray incase anything was missed.


No I disagree seems a waste
Reply 189
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electricjon
OP
Original post by Subcutaneous
Well as a junior may what a second opinion on xray, possible you missed something...then query why on your first day as an f1 you're not in a lecture theatre getting induction talks lol

Speak to family, get their perspectives and ask her what she makes of the radiographers comment (nicely ofcourse).

What is she rating her pain/the pain assessment? I'd scream munchausens..but that's just first impression.

Oh and maybe fluids up & 2-4l o2 if she's been on a fair whack of morphine to be on the safe side.


You run the x-ray past your senior. He says it's completely normal. The parents are distressed, saying "Please just help our daughter."

When you ask her about the pain, she shrugs her shoulders and says "I don't know! It hurts! 11 out of 10!"

Sats are 100% - no need for oxygen or fluids.
Calcium levels - could have brittle bones? :colondollar:

EDIT: could it be something to do with the ball-and-socket shoulder joint - the humerus may just detach for some reason?
(edited 13 years ago)
Reply 191
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electricjon
OP
Original post by Dekota-XS
Refer her to the radiographer again for a second x-ray incase anything was missed.


Second x-ray? Which shoulder?
Reply 192
Avatar for electricjon
electricjon
OP
Original post by thegodofgod
Calcium levels - could have brittle bones? :colondollar:


No. Her bones look fine and healthy on x-ray, and her calcium levels (which would take a couple of hours to do) are normal.
Original post by electricjon
You run the x-ray past your senior. He says it's completely normal. The parents are distressed, saying "Please just help our daughter."

When you ask her about the pain, she shrugs her shoulders and says "I don't know! It hurts! 11 out of 10!"

Sats are 100% - no need for oxygen or fluids.


Then have a bit of a chat with her, discuss conflicting stories and her frequent admissions. Id not want to give her a sedative tbh although she may need it as anxiety = pain. I'm reckoning a psych referral...lol but as the nurse I'd be more fed up with a patient I can't manage pain with!


If shes not drank/eaten in 10-12hrs due to pain then I would pop fluids up if prescribed anyway to stop her going dry.
(edited 13 years ago)
Original post by Subcutaneous

What is she rating her pain/the pain assessment? I'd scream munchausens..but that's just first impression.


Yeah I wondered that too
Original post by electricjon
Second x-ray? Which shoulder?


Left shoulder. Meanwhile administer a strong muscle relaxant by i.m. injection
Reply 196
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electricjon
OP
Original post by Subcutaneous
Then have a bit of a chat with her, discuss conflicting stories and her frequent admissions. Id not want to give her a sedative tbh although she may need it as anxiety = pain. I'm reckoning a psych referral...lol but as the nurse I'd be more fed up with a patient I can't manage pain with!


If shes not drank/eaten in 10-12hrs due to pain then I would pop fluids up if prescribed anyway to stop her going dry.


Her vitals are normal, and was having dinner just before her shoulder popped out. She is not thirsty. She is screaming in pain, saying her left shoulder is dislocated. She says that she knows her own body, and that this has happened a million times before, and she just wants you to fix it.
Reply 197
Avatar for electricjon
electricjon
OP
Original post by Dekota-XS
Left shoulder. Meanwhile administer a strong muscle relaxant by i.m. injection


You x-ray her left shoulder. It's normal. On returning from x-ray she seems a bit more comfortable, but still refuses to move both arms because of the pain.

Her left ankle now really hurts.
(edited 13 years ago)
Original post by No Future
Yeah I wondered that too


Exactly, although seems to obvious as she's fitting the bill textbook style...but this isnt real so yeah I'd pop my dollar on that.

Sounds like she just needs a cup of tea and a heart to heart- maybe go through her social history? Abuse etc.
What's her weight and BMI?

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