“You are the resident on duty at the ER and an eleven year old boy is wheeled in. He was stung by a bee fifteen minutes ago, and is now in severe respiratory distress. His blood pressure is 40/50, pulse rate is 140 beats/minute, and has a respiratory rate of 34 breaths/minute. His capillaries refill in about 5 seconds and his nail beds as well as his lips are starting to turn blue. What will you do?”*
As my mind raced to think of how this patient was to be managed, I felt the familiar rush of adrenaline such as I get during debates. The above scenario was just one of the 108 questions I had to contend with a couple of hours ago during my exam in emergency medicine. The last few weeks rocked! It was a sharp contrast from our first few months in medical school. For the first time, we touched on topics ranging from syncope (fainting) to anaphylactic shock, which is a severe, life threatening allergic reaction. These were real medical issues based from real emergency cases, unlike the *yawns* how-to-prepare-a-good-acetate-slide module of the last month.
Last sunday was my first ER (emergency room) exposure and boy, was it thrilling! We were on duty from 11 in the morning to 4 in the afternoon. The first two hours were uneventful. There was nothing to do but watch the Manny Paquiao versus Hector Velazquez super featherweight bout (Paquiao won by knock out on the 6th round! =P) shown on TV in the doctor’s quarters. They started coming in just after lunch. Our first trauma patient was a 20 something construction worker who came all the way from Olutanga in Zamboanga del Sur province. Two fingers of his left hand were missing and bits of skin and muscle were the only thing that kept a third digit from completely being severed from the rest of his hand. It turned out that he had boasted to his drinking buddies that a quitis (a type of firework-rocket) wouldn’t explode if he gripped it tighty (he reasoned out that since oxygen was needed for combustion, gripping the explosive tightly would prevent oxygen from entering thus preventing combustion). So much for poorly tested theories.
As the afternoon wore on, more patients streamed in. Most of them were MVA’s (motor vehicular accident victims). One elementary school teacher was hit by a motorcycle as she was crossing the street. She sustained a nasty cut on her head and a possible skull fracture. The intern in charge showed us how his gloved finger easily slid through the gaping wound and into the skull. As we were huddled around the school teacher, a middle aged man was rushed in with a bleeding ulcer. One of our instructors, who was on duty at the time, showed us how to perform a rectal exam and insert a nasogastric tube. My sympathies went out to the patient as he struggled to swallow the tube, gagging and choking along the way.
I guess the highlight of the day was when one of the interns let me handle a patient. Well ok, I didn’t exactly admit the patient but she let me take the history, do a complete physical and take the vitals. She even asked me what diagnostic tests I was to run and how I was to manage the patient. The best thing about this was that she agreed with what I thought should be done and that the patient was managed based on my suggestions. Haha! I went home that day feeling MD (murag doctor! hehe.)
The practical exams were fun!** I felt like Superman as I snatched a woman from the jaws of death, like McGuyver as I carefully threaded an improvised urinary catheter up a woman’s vagina. hehe. What was funny was my buddy Marvin’s reply after I asked him why he flunked the urinary catheter station. He said and I quote Cosa man yo sabe? Ya planta lang sila puki adelante kumigo kabar ya spera cosa yo ase! (What do I know they just placed a vagina in front of me and asked me what I should do with it!) Now that elicited a few laughs.
Feel the speed of thought. The words of my debate trainor echoed in my mind as I thought of what to do with an 11 year old boy in anaphylactic shock. Hmmm, maybe a dose of epinephrine would do. 0.1 mg/kg, 1:1000 dilution, IV. Or perhaps dyphenhydramine would do the trick? I opted for epinephrine followed by diphenhydramine. Here’s hoping I got it right! ;P
*The actual exam question was changed to protect the writer from any exam leakage charges.
**The emergency medicine module culminated in an Objective Structural Clinical Exam (OSCE) which was held yesterday at the Ateneo de Zamboanga University School of Medicine. The OSCE’s involved simulated scenarios with simulated patients and rescusitation dummies.