Your first day as a doctor

You ring up the hospital where she attended before. They dig out the case notes and x-rays, all of which fail to confirm that she ever suffered a single dislocated shoulder. The receptionist says "Oh yeah I remember this girl - she was a nightmare!"

she a (prescription) druggie?

Hold on, if she was having a meal prior to the pain than the pain could have been induced by changes in blood glucose levels. Run endocrinological tests.

Haha
Running any further tests won't help but get some immunological blood tests going for the sake of it.

she a (prescription) druggie?

An EEG if she's confused?

You run some endocrinological and immunological blood tests "for the sake of it". The results will take 1 week. She is about to breach the 4 hour target in A&E. Your charge nurse is getting annoyed at you and wants to know that the plan is.

You know what .. Refer her to a Neurosurgeon!!

This also crossed my mind

Send her to MAU!

Back to the case - a couple of the correct answers have filtered through now, so I shall tell you what happened.

The surgeon arrived at 1305, three minutes after the patient was declared dead. We had run out of blood, and so the patient just bled to death right in front of us. To be fair, even if we had all the blood in the world and the greatest surgeon in the world right there, he still probably would have spent months in ICU and still ultimately died. A pH consistently less than 7 is pretty incompatible with life.

Other things we could have done to buy him more time would have been to try and splint his pelvis by tying it in a sheet, but given the severity of the fracture, that probably wouldn’t have worked. We could have opened his abdomen in A&E and tried to stop the bleeding, but given his pelvis was filled with 12 litres of blood, swimming through it to find the bleeding vessel would have resulted in a torrential blood bath and would only have added to the gross indignity of this man’s death.

That doesn’t excuse the orthopaedic surgeon, who will no doubt be struck off for a) not being on site in the first place and b) taking nearly 2 hours to get to A&E.

It is interesting seeing the range of answers that people volunteer. Presumably, everyone who uses this forum is a prospective medical student or a current student doctor, but I didn’t expect such diverse thinking.

The most sensible answers came from regular and senior users like Penguinsaysquack , No Future and Carpediemxx who were able to take a step back from the huge bulk of technical jargon I threw in there, to consider the greater picture:

1) You are a newly qualified doctor – what the hell are you doing in A&E Resus and what the hell are you hoping to add to the situation, given you have senior registrars and consultants there? Just leave and go back to minors, or just watch and learn, or better still, try and help out as best as you can.

2) This guy is F**KED.

Those of you that gave frankly stupid answers, or asked for more information, or suggested random interventions, made up pathologies, or worried about confidentiality issues, have a long way to go as doctors. Medicine is about recognising what you know and what you don’t know, and if you don’t know, DO NOT GUESS. GET HELP INSTEAD. And if you can’t do that, stay away from me and my patients before you end up killing someone.

The medics refuse to accept the patient. "What are we treating again?"

I want you as my doctor. Give my diagnosis to me in terms I can understand.

"Sir, you're ****ed."

Ask her what the doctors did before to fix it?

fibromyalgia? any trouble sleeping/snoring?

Call the anaesthetist for advice?

The doctors in the Welsh hospital that saw her are either not on duty or are busy seeing patients. The receptionist can't make out their writing, but it looks like they didn't do much.