Cases from Casualty

I just returned from a week's attachment with psychiatry to return to my normal life in the Casualty department. Most of the time I just handling patients with trivial complaints, like flu/cold symptoms, food poisoning and minor sprains.

Sometimes I do groan when I see another kid come in just because he or she has had a fever for a few hours and it is not even that high. For those with you who have kids, your body's temperature should be below 37.3 degrees Celsius (I can't be bothered to figure what that is in Fahrenheit). Anything about 38.0 degress Celsius is what I constitute as a fever. The raising of the body temperature will not fry your kid's brain or any other organs in the body. Sometimes it will take a few days for the fever to go down. In 99% of cases it will be a trivial viral infection that just needs some medication for the ailments, plenty of rest and lots of fluids. You do not have to go and see the doctor at the first instance he or she has a fever. Try some anti-pyretics like Panadol/Tylenol and if that hasn't worked for a few days, then come see a doctor.

In Accident and Emergency I'm now on the front lines for the first time and having to diagnosis ailments. Before, I could rely on the Accident & Emergency doctors to have made a diagnosis if I was working in the wards or to have written a good referral letter if they are coming to the specialist out-patient clinic. Nowadays I have to determine what the patient has and do the appropriate management, most of the time without any supervision. So it is nice when I get a vital diagnosis right, which I will share.

Case 1
A 52 year old gentlemen with good past health presented to Casualty with per-rectal bleeding for half month, associated with a change in bowel habit, tenesmus (that's the sensation you want to take a poo but I can't), weight loss and mild abdominal discomfort. Whilst performing a per-rectal examination, there was a mass that could be palpable in the rectum. Naturally the patient was admitted to the Surgical ward. A flexible sigmoidoscopy and biopsy were performed the next day, showing he had cancer of the rectum. He was discharged a few days later to be further investigated for his cancer.

Case 2
A 29 year old lady with good past health presented to Casualty in mid-January for food poisoning features - abdominal pain, diarrhoea and vomiting. What was noted by me was her last menstrual period was late November 2009 - five weeks ago. I asked the nurse to perform a pregnancy test on her. It turned she was pregnant and didn't even know about it. An ultrasonogram was performed just to exclude ectopic pregnancy and she was referred to the Early Pregnancy Assessment Clinic.

Case 3
A 15 year old boy came to Casualty for six month history of cough and wanted to know why he was coughing so much. Turns out he's a chronic smoker!

What Casualty has taught me is that the general population is ignorant about their own health like I'm in finance. I know nothing about money and don't want to learn anything about economics and will ask stupid questions about it.