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Tonight, (我们都忘了回家的路~~=P) I had my first taste of what being a doctor is like. Of course, I had absolutely no clue about what I was doing and in general didn't really have a differential so I wasn't much of a doctor anyway. But yes, tonight...two patients. Let's discuss the first one.
Case 1
Female, ~20yo, Student
Tight piercing pain just inferior to the sternum since this morning accompanied with nausea and vomitting. Patient was curled up in bed in pain so I assume the pain was close to 10. She had drank 3 bottles of whisky the night before and since this morning, had only eaten some congee and chicken soup (most of which she vomitted up). In terms of medication, she has taken some potassium citrate and a chinese medicine for 入风 (obviously haven't helped).
Provisional Dx: Gastric +/- hangover from the alcohol she drank last night.
Rx: Metaclopramide followed by Rantidine hydrochloride 15 minutes after.
Of course, that all sounds really professional. Honestly though, most of that came from the pharmacist in Clayton Priceline. It looked like she was feeling better when we left and I advised her to take another tablet of Rantidine in the morning and to drink lots of fluids the next day. Then I went home to my other patient:
Case 2
Female, ~21yo, 2nd year medical student
Sudden onset of headache since late afternoon. Frontal localisation with accompanied nausea. No actual vomitting. Patient has been symptomatic with cold for the past week. Headache was a 4 in the afternoon. Then with administration of paracetamol 1000mg, pain subsided but returned at approximately 8:15pm (pain had worsened to a 6 at this stage). Patient found that applying pressure on forehead helped alleviate pain. I then took her to ED at MMC at which point the pain had subsided to a 1 (huh? O_O) Possible placebo effect of hospital aura is suspected. After two hours of waiting, we were admitted and the ED (beautiful German) doctor made a provisional Dx.
Provisional Dx: Tension headache.
Rx: Codeine phosphate + recommendation of bedrest and fluids.
Haha, as you can all see, I really wasn't much of a doctor for the second patient (for those who are really thick and haven't figured things out, it's Yeu Sheng). It was about 12:30am when we left the ED and thankfully, she was feeling much better compared to just after dinner. It's fair to say that the codeine didn't really work though (maybe it has something to do with all the Panadeine she took when she was sick with the cold). She's feeling much better now...and even cooking for the third patient...
Case 3
Male, ~19yo, 2nd year medical student.
Gradual onset of sorethroat and dull headache (around the level of 2) accompanied with rhinorrhoea. Suspected to have caught the cold from patient 2. Has been given honey lemon and strepsils for the sorethroat and paracetamol 500mg for the headache.
Provisional Dx: Being a good boyfriend.
Rx: Sayang and rest.
Yeah...you can all laugh and smile but I really am sick at the moment so just be cautious around me =P
Just about the title, meningitis is apparently always a DDx for a patient presenting with headache/migraine Sxs. So, when you get a patient coming in with a headache, always examine for:
1) Pyrexia
2) Photophobia
3) Neck anteroposterior rigidity
4) Rashes (particularly lower back)
Case 1
Female, ~20yo, Student
Tight piercing pain just inferior to the sternum since this morning accompanied with nausea and vomitting. Patient was curled up in bed in pain so I assume the pain was close to 10. She had drank 3 bottles of whisky the night before and since this morning, had only eaten some congee and chicken soup (most of which she vomitted up). In terms of medication, she has taken some potassium citrate and a chinese medicine for 入风 (obviously haven't helped).
Provisional Dx: Gastric +/- hangover from the alcohol she drank last night.
Rx: Metaclopramide followed by Rantidine hydrochloride 15 minutes after.
Of course, that all sounds really professional. Honestly though, most of that came from the pharmacist in Clayton Priceline. It looked like she was feeling better when we left and I advised her to take another tablet of Rantidine in the morning and to drink lots of fluids the next day. Then I went home to my other patient:
Case 2
Female, ~21yo, 2nd year medical student
Sudden onset of headache since late afternoon. Frontal localisation with accompanied nausea. No actual vomitting. Patient has been symptomatic with cold for the past week. Headache was a 4 in the afternoon. Then with administration of paracetamol 1000mg, pain subsided but returned at approximately 8:15pm (pain had worsened to a 6 at this stage). Patient found that applying pressure on forehead helped alleviate pain. I then took her to ED at MMC at which point the pain had subsided to a 1 (huh? O_O) Possible placebo effect of hospital aura is suspected. After two hours of waiting, we were admitted and the ED (beautiful German) doctor made a provisional Dx.
Provisional Dx: Tension headache.
Rx: Codeine phosphate + recommendation of bedrest and fluids.
Haha, as you can all see, I really wasn't much of a doctor for the second patient (for those who are really thick and haven't figured things out, it's Yeu Sheng). It was about 12:30am when we left the ED and thankfully, she was feeling much better compared to just after dinner. It's fair to say that the codeine didn't really work though (maybe it has something to do with all the Panadeine she took when she was sick with the cold). She's feeling much better now...and even cooking for the third patient...
Case 3
Male, ~19yo, 2nd year medical student.
Gradual onset of sorethroat and dull headache (around the level of 2) accompanied with rhinorrhoea. Suspected to have caught the cold from patient 2. Has been given honey lemon and strepsils for the sorethroat and paracetamol 500mg for the headache.
Provisional Dx: Being a good boyfriend.
Rx: Sayang and rest.
Yeah...you can all laugh and smile but I really am sick at the moment so just be cautious around me =P
Just about the title, meningitis is apparently always a DDx for a patient presenting with headache/migraine Sxs. So, when you get a patient coming in with a headache, always examine for:
1) Pyrexia
2) Photophobia
3) Neck anteroposterior rigidity
4) Rashes (particularly lower back)
i must clarify here..."tonight~~我们都忘了回家的路~~" is part of the lyrics of Gary Cao's song... we managed to find our way home =)
Hahahah..I was wondering who that 19-year-old male medical student was till you revealed more about him. Totally slipped my mind that you are still that young.. :P
er...thanks...i think...=/
that's why my nickname is 老大牛 =P