Gaaaaaaaaaaaaaaaaaaaaah.

So, I just got home from work and found this: Med interview email

Gaaaaaaaaaaaaah! How exciting is that?!

So much to do! I need to read up on MMI, I need to get a haircut, I need to buy a new suit, I need to book my train and sort out my accommodation.

I’ve been waiting for this for FIVE YEARS and I’ve been offered an interview at my first attempt! So happy 🙂

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Respiratory Distress in Infants

Building on my last post, I’ve found this youtube playlist of some short videos of infants in respiratory distress. From my year, so far(!), in Paeds ED, sepsis and respiratory problems have been the two most common medical reasons for admitting kids to PICU (ie the reasons why kids are big sick). And as winter comes round, there’ll be more and more bronchi kids

It’s really important to be able to recognise the seriously ill child, and if you can pick up on on these respiratory signs you’ll be doing pretty well. Before I add the links, just a quick point; we in the UK call the sucking in of various bits of the chest ‘recession’, but in the US they call it ‘retraction’.

So, here goes:

This is a really good example of ‘tracheal tug’; where there’s a big sucking in around the trachea. Really pronounced tracheal tug can be a sign of very severe respiratory distress. In adults with respiratory distress something you look for is someone who can’t speak in full sentences – this baby clearly cannot ‘speak’ in full sentences either.

In really small infants they ‘head bob’ because their neck extensor muscles are weaker than older kids.

This one’s particularly grim; it shows a small infant with horrendous sternal recession and tracheal tug. Sternal recession generally shows respiratory distress at a more advanced stage than intercostal and subcostal recession alone. These kids are often pretty sick. You can really hear the stridor as well

This video’s similarly unpleasant; it shows an older child with pretty much his whole chest sucking in (you can see this better at 00:14). This video appears to show the child being bagged.

None of these videos are particularly nice to watch, but they are very informative for any students doing paediatric placements.

And to make you feel better, here’s a video of a happy infant with puppies 🙂 

Cannulation

With all that goes on in A&E, cannulation doesn’t excite many people, but I find it really satisfying.

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Knowing that your efforts in getting a cannula in can make a big difference is someone’s life is a very rewarding feeling. Just today, my patients have been able to have medications for life-threatening conditions and strong pain relief because they were successfully cannulated 🙂

It’s all getting a bit real

I’ve just got home from a UKCAT course and everything is creeping up on me a bit!

My exam is in under six weeks now, and that’s pretty terrifying, but what’s even more terrifying is that I’ve changed tack a bit; instead of doing three UKCAT grad courses and one undergrad course, a friend has convinced me to do the GAMSAT as well :O; I’ll be applying to two UKCAT and two GAMSAT courses. As someone who doesn’t have a very sciencey background it will require a lot of work, but my eyes have been opened to how many more opportunities you have with the GAMSAT.

So, the new list is Warwick, Newcastle, Nottingham, and Swansea. Not applying to the KCL grad course seems like a sensible idea because it’s so ridiculously competitive, so so so competitive. And not applying for a five year course makes more sense as well; who has £36k lying around?!

Of course only time will tell, but I found that UKCAT course really useful today. I now have a systematic approach and the tools to get a high score. How the test goes on the day is a very different matter.

Hannah and her mum

Hannah had had a good day and was driving home with a smile on her face. Today she’d finalised the most time consuming contract of her fledgling legal career. She was planning her celebratory evening in her head when she felt her pocket vibrate, she looked down at her boyfriend’s text. This is where Hannah’s story ends.

About 90 minutes later Hannah’s mum walked into the hospital reception desperate for information. She’d raced to A&E after she’d received the call.

‘Hello, Mrs Green? I’m calling from the hospital, your daughter’s been involved in an accident and she’s had to be airlifted in. Please come as soon as you can.’

When she went to the reception desk, not wanting to be rude, she waited her turn. When she told the receptionist her story, his world weary expression softened and he walked her to the relatives’ room. After what seemed like an eternity there was a knock at the door and a little Indian man walked in. Mr Patel took the seat next to Mrs Green and began to talk, ‘Mrs Green, your daughter suffered extensive brain injuries and is very unwell, she’s going up to intensive care now, but I must warn you that she’s unlikely to wake up.’

Hannah’s mum’s face crumpled.

Peculiar Morning

Odd morning so far, I was polled for the first time ever on the way out of the house this morning…torn between the Lib Dems and the Tories.  As an NHS employee I’m supposed to vote Labour, right? I can’t bring myself to, some of their policies are just idiotically populist.

After that I found £100 on the street and handed it in to the police…I’m a little bit scared it was drug money and I’m going to be hunted down by some drug lord.

And just as I was writing this I chased a balloon down the street that’d been dropped by a Latvian clown.

Anyway, I’ll try and get a proper post up soon but I have a tricky couple of weeks. Coursework in on Monday, then an exam 1st May :/