Just Some Rants

Just some random thoughts. Having had 5 calls so far (including THREE weekend calls), I can seriously conclude that medical calls are the maddest of all. Two MOs (1st and 2nd call) covering everything...it's more tiring that I could imagine.

Anyhow, it seems that there are some new blood in A&E and are somewhat problematic. Having switched position from casualty MO (admitting cases) to medical MO (receiving cases), now I fully understand that if patients were not adequately stabilized/ correctly diagnosed/ admitted with true indication, it's really a suffer for the receiving end.

Just some examples of:
1. Not adequately stabilized
- Eg. Acute coronary syndrome not given aspirin/GTN, acute heart failure not given frusemide, asthmatic patient not on oxygen during transferring etc. I mean, what's the difference between these and the patients come directly to the ward? They need to be given emergency treatment before admission!

2. Not correctly diagnosed.
- This is seriously a big problem which I wanna rant it out (been keeping it for sometimes). Imagine you got a call that there's a pregnant lady presented with atrial fibrillation, will you put down whatever things on your hand and run to the casualty? Then what you see is actually just a sinus tachycardia.
Patient get admitted for "ischemic changes on ECG" which is T-inversion in aVR and V1. Will you be mad?
What's more, there are some diagnoses that you won't figure out the logic.
"TRO cardiac thrombosis secondary to deep vein thrombosis"
"Hypertension secondary to portal hypertension" (Feel like scratching your head??)
"AECOAD secondary to CCF"
"Fever with thrombocytopenia TRO Hemolytic-uremic syndrome" - Sounds impressive? Which the patient's presentation is typically a Dengue fever! So do you wanna impress others that you know such diagnosis exist, or did you just do the opposite which shows that you can't even diagnose a Dengue fever?
And many many more...

3. Not indicated for admission.
- When the ward is full and with extension beds plus plus, the care will definitely be relatively less with the same manpower. But if the admissions still keep on coming in, with diagnoses of:
"Postural hypotension ?diuretics-induced" (What's the indication of admitting the patient? Can't just off the diuretics?"
"AGE with no dehydration"
"Uncontrolled DM with glucose 15mmol/L)
I mean, most of the patients actually can be managed in casualty's observation ward and discharged home. Most of the time, one of the biggest problems we've got is ward's full, and no bed when the real emergency cases come!

Hmm. Guess that's about it for now. Not sure whether I said too much.
Hope things will get better!