A&E placement

Simply amazing!

It was not just that I have learnt so much stuff in a week. It's the whole pleasant atmosphere of being there. It was a district general hospital I was attached to and the the department is divided into the ED and the Urgent care centre (UCC). I usually spend half a day at the UCC and the other half at the ED.

Here are the summary of stuff I've learnt:
Monday
- Abdo pain (child), Ortho exam (foot) and intepreting x-rays
Tuesday
- ECG (T invertion and bigeminal rhythm), Heart failure (cause and management), Convulsion (febrile), Bronchiolitis (infant), Unstable ankle fracture and reducing it, Trop-i increase (causes), D-dimer, Assessing bone/joint injury/pain, Assessing pleuretic pain, Assessing trauma to chest wall
Wednesday
- Plastering, Cardiac arrest, Apical pansystolic mummur in anaemia, Bad practices, Severe abdo pain, Inserting femoral line, Checking BM
Thursday
- Assessing painful arm and shoulder, Pain relief in A&E, Inserting venflon and taking blood, Swollowed foreign body (management), Log roll, Positioning for x-ray C7 view, Scalp laceration, Tonic-clonic seizure (causes), Haematemesis, Bad discharge, Causes of faint/collapse, Allergic reactions, Common causes of infection in elderly, ECG (Supraventricular tachycardia), Sudden onset of 'unwell'
Friday
- Foreign body in the eyes, Trauma to shoulder and chest, Whiplash injury, Performing 12-lead ECG, Triage, Fractured neck of femur (external rotation and shortening), Fractured pelvis, Managing seizure, Hypovolaemia (signs and symptoms), Stem cell transplant (inflammatory reaction)

So you see I've seen quite a bit, and I've still got so much to learn! I must say I was rather apprehensive at the beginning because the only system in the body that I am well versed in is the GI tract and the genitourinary system; whilst at A&E patients pop in with all sorts of problem. But after my first day, I know I need to learn to examine all the major systems in the body, which will be quite overwhelming. In addition, I get to see the patient before the doctor does, write up the history and examination finding, discuss possible diagnosis and suggest investigations and further management for the patient.

On my second day two registrars gave me some tips:

'If you have a bad experience here, don't take it as a representation of the speciality' - that's probably quite useful because the department is extremely busy most of the time, and we always have managers harassing the medical staff, telling doctors what to do.

'Ask lots of questions, don't hide around the corner' - that's what I've been trying very hard to do. It was understandably difficult for the first few days and I did feel a little neglected. But I realised that, like placement anywhere else, I've just got to look interested and offer to do anything for the doctors and nurses. Otherwise people just won't notice me, or won't even realise who I am after four weeks in the department if I keep on shying away.

And one of tips from a consultant: 'Learn anything. Anything you can lay your hands on or anything you can observe. Even with things like adjusting the bed's cot side.' - That is quite helpful because as a student there isn't much I can be very helpful at and it's only these very simple things I can do to feel a little useful.

There is only one thing. A consultant said I need to wear a white coat. Ever since he told me that, he asked me everyday where is my white coat. I kept on saying 'next week'. So from next week onwards I will have to wear a white coat. I'm going to look so weird...