Thursday, 27 August 2009

Patient: Abdominal Wound

Bob, normally healthy 23 year old male presenting with abdominal stab wound. Unconscious, Pulse 150, BP 60/30, Resps 27. Appears diaphoretic and ashen.

This is a patient we saw(minus a few identifying facts) in A&E. I thought I would outline how we treated him.

He was clearly in hypovolemic shock. His blood pressure was incredibly low so his heart couldnt pump the oxygenated blood to his cells. To attempt to compensate for this his pulse increased. We start getting concerned when a patients pulse exceeds their systolic blood pressure, its a sign of acute shock. In order to keep pace with the heart and oxygenate the increasing blood flow(increasing at first) his breathing became shallow and rapid. However long before this he would have passed out, Its not clear weather this is another one of the bodies failsafes or just coinsidence but an important step in immediate treatment of shock is to lay the patient down, preferably with their feet up so as much blood as possible is flowing to the brain. His blood vessels would contract in order to attempt to compensate for the plumetting blood pressure this would have caused the ashen appearance.

Going back to basics.

Airway/Breathing - the patient had a patent airway but his oxygen intake from the shallow breaths was insufficient so we placed him on highflow oxygen(15litres via non-rebreathe mask).
Circulation - We applied a heavy dressing and applied as much pressure as we could in order to slow down the blood loss. We obtained venus access. This was particularly difficult as he was peripherally shut down. We then pumped as much saline and gelofusin into his veins as possible increasing his circulating blood volume and taking blood for typing. Short term its important to increase the circulating volume with anything we have at our disposal, it will increase the blood pressure and hopefully decrease resp and pulse rates. Long term however the lack of red blood cells will cause hypoxia(among other things) despite the high flow oxygen. At this point several units of blood for transfusion appeared and he was deemed stable enough to risk surgery to repair the damage caused by the knife.

All this happened in a very short period of time, the patient survived(surprisingly).

Sunday, 23 August 2009


Its been an insane week. Many stressful situations which are thankfully now resolved. So I am now sat in my living room, alone(my fiance is on nights). Drinking a blended whiskey(I am normally a single malt man but this isnt a bad one). With my entire music collection on random(thats a lot of music). So I thought in the interests of pure laziness and at the risk of a massive blow to my standing amongst my loyal readers I would post bellow ever song that comes on. In bold you'll see any excuse I wish to make. May the comments begin!

Iron Maiden - Face in the Sand
Deep Purple - Black Night
Dreamevil - Book of Heavy Metal
Queen - Mad the Swine
Nirvana - Opinion (I have no idea how this got on here)
Luke Kelly - The Town I loved So Well
Corrib Folk - Wish it was Sunday
Anastacia - Secrets(I have no idea how this got here either)
Johnny Cash - The Wall
Hammerfall - Take the Black(Nothing like hammerfall for destressing)
Iron Maiden - Seventh Son of a Seventh Son(Parts of this song sound very Greek)
Van Halen - Running with the Devil
Toad the Wet Sprocket - Somethings Always Wrong(I love this song)
Savatage - Handful of Rain(My usual drinking song with a good video)
Ludovico Einaudi - I due Fiumi
Thin Lizzy - Jailbreak
Bad Company - Bad Company
Iron Maiden - Intro:Churchills Speech(One of histories greatest speeches)
Sonny Rhodes - Firefly Theme
Skyclad - Spinning Jenny(A truely Filthy Song!)
Elexorian - Dryads and Trolls(Hillarious lego video available on youtube)
Plain White T's - Every Second Counts
Skyclad - Any Old Irony?
Tyr - Ormurin Langi
Bon Jovi - Wanted Dead or Alive ("Bon Jovi Rocks....On Occasion")
Amateur Transplants - Anaesthetists Hymn(Medical Spoof Band, Highly Recommended)
Thirteen Senses - Into the Fire
Bruce Dickinson - Inertia
Free - Wishing Well (One of my Favourites)
Lynard Skynard - Freebird(This was my fathers song)
Iron Maiden - The Trooper
Kansas - Fair Exchange
Led Zepplin - Immigrant Song
Kenny Rodgers - The Gambler

Ok I'm going to end it there, that wasnt nearly as bad as I was expecting.

Monday, 17 August 2009

Broken Squirrels

Shortly after returning from the lake district recently I was sat in my local with a friend and we were discussing the complexity of reintroducing red squirrels to the south. The concept is referred to in ecological circles as humpty dumpty communities. The intruder greys came in and won dominance over the red squirrel. It seems the solution is simple, remove the grey squirrel and reintroduce the red squirrel but it is far from that simple. A species often has different requirements to establish themselves in an environment. A certain insect or plant which has long since died out may be required in abundance to allow the red to reach the necessary numbers in the initial stages in order to survive in an environment long term. Many people say they prefer the red squirrel but ultimately evolution has led to the rise of the grey squirrel and as much as many would like to see a predominantly red england again, what right do we have to tamper with the progression of nature?

The grey squirrel is larger, more aggressive and more of their progeny are likely to survive infancy. This clearly placed them at an advantage over the more timid, less hardy red squirrels.

This concept is best explained by Olivia Judson(one of my heroes). Whilst I was in the lakes I asked my fiance(a northern lass) why the grey squirrels dont seem to have penetrated the lake district(loads of red squirrels and I've never seen a grey in the lake district). Her reply made me laugh "we're better shots than you".

I am aware that some of my readers are avid gardeners and I would like to ask for any tips when it comes to battling white fly on my pepper plants. Every year about 75% of my plants are ruined by the little buggers.

Friday, 14 August 2009

My Return

I have returned. I decided to take a little bit of time away from blogging(and the computer) whilst I was on my A&E placement just so I could keep focused. That placement is now over and I am really going to miss it. When I qualify I fully intend to find a job either in that A&E department or to one in a local hospital.

Now down to the business of the day. As many of you will have heard President Obama is presenting the idea of a government funded healthcare system(a bit like our own) in the US. This has been met with fairly aggressive opposition and frankly more than a little sniping at our system in order to discredit it. The problem is, as I see it. most if not all hospitals, pharmaceutical companies, etc in the US are businesses, they have many investors who will suddenly lose a lot of money if free healthcare finds a place. The current system mean thats most americans only have access to healthcare if they can afford it, leaving those that cant in a pretty sorry state. There are of course a few very badly funded, understaffed, underequipped services trying to cater to the needs of those who cant afford the care they need but it is wholly insufficient.

The problem here is how do you introduce a state funded system that will rival big businesses in an entirely capitalist society?