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    (Original post by UpsidedownLandMan)
    the first one, distended prostate guy.
    IIRC, he had an open book pelvic fracture, several litres of blood in his abdomen and eventually died from his wounds despite their best efforts.
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    poor fella.
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    (Original post by *pitseleh*)
    *yawn*

    Some of us belong firmly in the 'common man' category, thanks.

    Muppet.
    there you go lol, another doctor is the common man, what do you think of your patients? no wonder all the research went to the states. oxbridge - all show.
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    (Original post by FailWhale)
    no wonder all the research went to the states.
    LOL
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    (Original post by FailWhale)
    lies, oxbridge grads aren't real doctors. none of them had a sex life before 20 besides lying about it in surveys, they don't have any clue what the average person out there does with their time, and are generally completely disconnected from the common man - intentionally so.
    I went to cambridge, was raised by my gran who cleaned houses for a living and have 3 brothers who are a morrisons baker, a carpenter and a barman with 2 kids (my youngest bro - 20 years old).

    Fail...
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    (Original post by electricjon)
    Thanks Sherlock. Admittedly I am young to be considered a registrar but I have worked in my A&E department for over 12 months. I'm not on an ACCS training programme but I do have experience and responsibilities that extend beyond those of an SHO (such as teaching and supervising medical students and junior A&E doctors) as well as following the "registrar" rota, attending specialty training sessions, receiving "registrar" rates of pay and being the quickest doctor in the department (based on the number of patients seen per hour).

    Yes the use of the term "registrar" is a bit dated post-MMC, but even ST1's technically can be considered a "specialty registrar" even if they may still be at SHO level. As it is, most ST3 ACCS trainess have at best 10-12 months A&E experience, so I feel the term is justified. I will concede that "junior registrar" or "middle grade" might be more appropriate but I really didn't expect people to care - certainly I have never been pulled up for it at work, but since it clearly bothers you I have changed it to A&E Doctor.

    Bit of a patronising way to go about it if you ask me. IF I MAY BE SO BOLD, didn't you study at Cambridge? So presumably you studied "medical sciences" instead of medicine, which means you are largely a research-based academic, and not really a proper doctor?
    Bit of an over reaction to a relatively innocuous question really.
    The correct reply would have been 'no I'm a staff grade/midle grade'.

    Emergency Medicine need passionate and dedicated doctors, which you clearly are. But not the arrogance of thinking that a year or two in the ED will make up for lack of bredth of education.

    Pure ED training leads to triage minors monkeys. Nothing more. People who brag how many people they have seen and not thinking about the quality of care they received.
    Thats why the college was formed and why it organised formal training pathways.

    As for the Cambridge comment, one thing cambridge people often remember is 'Do not tred on the grass until you make the grade' [you can only walk on the grass when you have graduated]

    Very disappointed really. People appreciated having some thought stimulating cases. However obviously a raw nerve was touched hence the over the top reaction.
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    (Original post by electricjon)
    You give her more morphine. It doesn't settle her, though she is starting to get a bit drowsy...
    Anaesthetic

    Haha, no, I'd just do the defibrilator thing to wake her up
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    (Original post by FailWhale)
    there you go lol, another doctor is the common man, what do you think of your patients? no wonder all the research went to the states. oxbridge - all show.
    Que? I've come from a working class family to Oxford, and have worked for four years as an auxiliary nurse to fund my studies.

    Sure, there are silver-spoon people here. But it irritates the **** out of me when people assume we're all like that - I've had to work bloody hard to get here, and shouldn't have to make apologies to people who apparently have very little idea of what they're talking about.
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    i hope this thread doesn't die just as i find out about it, it's brilliant.
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    hmm. Anyone got a case?

    Shall we return to the original purpose of this thread? (i.e. Medicine, not arguing about Med schools)

    I shall attempt to pick up the banner, please be nice to me, i've never done this before.

    Medic's Report: “The patient’s daughter went to visit him in his assisted living apartment today and found him lying on the floor moaning. She called 999 for his altered mental status. He began vomiting en route and was not protecting his airway, so we intubated him. He then started moving, so we gave him vecuronium and versed. The daughter did say that there was vomit on the floor of his apartment as well. She had talked to him yesterday, and he had complained of some abdominal pain. She is on her way.”

    History: Patient has a history of heart failure with an EF of 15%.

    Patient arrives intubated and chemically paralyzed with O2sats 86%. Note diminished breath sounds above right lung and uneven chest rise. Also has hemotoma on forehead.


    I think thats all for starters. Go easy, i'm not even a med student yet
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    (Original post by UpsidedownLandMan)
    hmm. Anyone got a case?

    Shall we return to the original purpose of this thread? (i.e. Medicine, not arguing about Med schools)

    I shall attempt to pick up the banner, please be nice to me, i've never done this before.

    Medic's Report: “The patient’s daughter went to visit him in his assisted living apartment today and found him lying on the floor moaning. She called 999 for his altered mental status. He began vomiting en route and was not protecting his airway, so we intubated him. He then started moving, so we gave him vecuronium and versed. The daughter did say that there was vomit on the floor of his apartment as well. She had talked to him yesterday, and he had complained of some abdominal pain. She is on her way.”

    History: Patient has a history of heart failure with an EF of 15%.

    Patient arrives intubated and chemically paralyzed with O2sats 86%. Note diminished breath sounds above right lung and uneven chest rise. Also has hemotoma on forehead.


    I think thats all for starters. Go easy, i'm not even a med student yet
    How old is he? Is he diabetic? Is he on fluid restriction for HF?
    Take ABG, check trachea and rule out PT and tension PT. CXR. Urine dipstick. THe versed could be the cause of the low o2 sat but then it could be a hundred other things. Get his GFR.
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    (Original post by sidewalkwhenshewalks)
    How old is he? Is he diabetic? Is he on fluid restriction for HF?
    Take ABG, check trachea and rule out PT and tension PT. CXR. Urine dipstick. THe versed could be the cause of the low o2 sat but then it could be a hundred other things. Get his GFR.
    GFR: 110

    CXR:



    ABG:

    pH 7.37
    pCO2 38
    pO2 52
    O2 Sat. 86%
    HCO3 26

    He is on meds for CHF and HTN. This is all we know.
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    (Original post by UpsidedownLandMan)
    GFR: 110

    CXR:



    ABG:

    pH 7.37
    pCO2 38
    pO2 52
    O2 Sat. 86%
    HCO3 26

    He is on meds for CHF and HTN. This is all we know.
    urgh acid base balance stuff.
    examine the patient. get an ecg monitor on him. watch and wait and ask for senior advice.

    Also what ever it is under CXR i can't see it. I assume it's an xray picture but i can't see it
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    (Original post by sidewalkwhenshewalks)
    urgh acid base balance stuff.
    examine the patient. get an ecg monitor on him. watch and wait and ask for senior advice.

    Also what ever it is under CXR i can't see it. I assume it's an xray picture but i can't see it
    bugger...

    CXR is here
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    (Original post by sidewalkwhenshewalks)
    urgh acid base balance stuff.
    examine the patient. get an ecg monitor on him. watch and wait and ask for senior advice.

    Also what ever it is under CXR i can't see it. I assume it's an xray picture but i can't see it
    bugger...

    CXR is here

    ECG shows normal for a patient with low O2 sats.
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    still not going through on that link, but when i quoted you i noticed the url and got it from there. I'm just going to embarrass myself now by trying to play doctor but oh well.
    If the patient is stable enough i'd like to get a head CT

    that and put the patient on high flow oxygen if he isn't already
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    Head CT is normal. I would take another look at that chest xray.

    EDIT: and don't worry, i'm probably going to embarrass myself by playing at doctor too.
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    I can't work anything out without reference ranges

    I'm ashamed
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    durr i hate cxr they all look the same to me.
    need to pull back on that tube so it isn't so far in the lung.
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    (Original post by Musty_Elbow)
    I can't work anything out without reference ranges

    I'm ashamed
    look them up on wiki for a rough guide. pa02 is low, bicarb is slightly high probably because of the vomiting
 
 
 
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