Traction!

Warning ! This is not top gear! This is traction in medical terms, something that actually equals pain! Today was another day in the Accident and Emergency Department for me. The day started smoothly as I saw a man with haematuria (blood in urine), who had a long term catheter due to a history of haematuria and retention eight years after his radical prostatectomy (diagnosed with low grade prostate cancer). He tried to drink in order to get clear sample (no blood) and dipstick his urine but that was not possible as the catheter bag was full of blood. Differentials of this case could be infection due to catheter, trauma (irritation) again due to catheter and there would be a need to exclude bladder cancer. As a result, doctors decided to do a blood test on him (FBC and U&Es). I attempted to take blood off him but I was not successful in my attempts. Another 5 people tried and it seems that he was a difficult candidate unfortunately. In the end, after a lot of stabbing they managed to get blood off him. Around this time I was off to see someone else, so not sure what happened to him and how they managed him exactly which is a shame. However, I had a read about haematuria and that was very interesting. There are so many causes for it. I think the most sinister cause is bladder carcinoma, however it is wise to think of it as macroscopic and microscopic and think possible causes for both types of haematuria. One thing I learned is that I will start associating it more with kidney stones, which are rather common. Apparently food high in oxalates could be a reason for kidney stones. Foods high in oxalate include rhubarb, tea, spinach, nuts! Just goes off to show how diet is important in our lives and our physical health. Gout is another disease that is associated with foods high in purine which include beer (alcohol), yeast, meat, legumes, cauliflower etc. Gout is not a nice thing as I saw a man today with knee joint swelling that was causing him a lot of pain. The acute treatment of gout is NSAIDs such as naproxen or diclofenac. Before giving NSAIDs make sure you answer about allergies and also if there is risk of ulcers of some form. The long-term of preventitive treatment for gout is allopurinol.

N xt patient a little girl that fell on her hand whilst playing tennis. The x-ray showed a greenstick fracture so the management was to put it in plaster for 6 weeks until it heals. In this case it was important to examine neurovascularly - check if pulse present, check sensation, check power and tone - and also check for tendon rupture by testing for the different flexor tendons in the arm, specifically FDP and FDS etc. She was neurovascularly intact so there were no worries there. The only problem with having her arm in a cast was that she was meant to be flying in 3 weeks so she was advised not to do any swimming whilst on holiday and get a fitness certificate (fit to fly). Some airlines have been rather funny with allowing people in casts to fly which can be reasonable. However, the SpR said that she could fly but she would need to have the cast split before she flew out, which could be an option.

Another little lady had a similar fall and injury to the one above but her's was a Buckle / Torus fracture, which is still within the greenstick type of fractures, but it is more like a ring fracture.

Finally, the most exciting bit of the day was an 81 year old lady with a wrist injury. Xray showed Colle's type of fracture. There was definitely impaction and some displacement. The wrist looked very swollen and tender +sore on palpation. It was sore when flexing or extending the wrist. As a result they decided the only option for her since she was 4 days post injury was to do a haematoma block (local anaesthetic) and traction. I was mainly supporting her arm during traction and that required some effort! However, it was exciting as it was the first time I was taking part in something like this!! After traction, she had an xray to see if it all went back to place but I had to go before the xray was taken as it was late.

Today, this young guy,only 19 years of age, came in and had two of his fingers amputated by holding onto a swing. I got to take history from him and then the SpR got to clean the injury site. He was in a lot of pain but they gave him some morphine for the pain. Also, to clean it we had to do a digital block by using a short acting and a long acting anaesthetic (lidocaine + bupivacaine). Sometimes, adrenalin is used in combination with a local since it causes vasoconstriction and prevents excess bleeding, but in this case/scenario it was not appropriate apparently. After that it was decided that he was going to be referred to a hand surgeon for terminalisation. At that time I had my assesment from one of the SpRs and learned how to do a hand examination although I still need to practise a bit to perfect my technique! Another thing I need to practise is knee examination too!

Oh well, this was my last A and E day and I must say I did enjoy it! Next week it 's paediatrics so hold tight for a series of paediatrics coming up!

Ciao for now ....

Have an awesome weekend ...!

P.S Quote of the week: 'l

'Love is not what you want, it is what you are. It is very important to not get these two confused.'