Gap Medics part 3: emergency room placement

I’m checking in at Seoul, South Korea now and I want to reflect on my last week of my Gap Medics placement in emergency room (ER).

During my first day, it was quite quiet so Dr. Fon went through some basic ER theory. There was a boy who had 2 stitches on his head taken out in the wound dressing room. There was a woman involved in a motorcycle accident that had two grazes on her foot and pain when moving her chin – she was fine after. A boy that was climbing steps had tripped on his head, so his wound was cleaned and sutured. Then it started to get busy – there was a nose incision and 2 laceration cases involving hands.

On my second day, we worked with Dr. Chang – such a cool doctor to hang around with. There was a brain stem haemorrhage case and Dr. Chang taught us about a brief test where you scrape the foot of the patient and observe the patient to see whether the stroke involves the meninges. If you stroke down the sole of the foot and there is movement on the opposite side of the lip, this indicates a frontal lobe lesion. If you stroke up the lateral side of the sole and continue medially: toe extension indicates meningeal irritation, no movement indicates normality, wasn’t sure about toe flexion. There was an 18 year old female with abdominal pain, guarding, right lower quadrant pain, fever, chills, irregular/tachycardia – possible appendicitis and sepsis. Multiple intravenous (IV) lines were put in for return of spontaneous circulation (ROSC) and antimicrobials against gram negative, anaerobic bacteria. We also saw surgery for enlarged veins in the knee. There was a 1 year old boy who had been bitten by a dog on the head, so he required rabies immunoglobulin injection. A male came in having sliced his finger due to a paper cutter – wound was cleaned, local anaesthetic was applied and he had it stitched up. There was a 10 year old boy who had run into the table and required stitches above his right eyebrow. Another child ran into a shelf and had stitches on his right eyebrow (shaved). There was a man who had a mass removed and a mole removed from his neck – this required an excision, stitches and cauterisation. Lastly, an elderly woman had an infected on her foot cut out rather than cauterised, as heat from cauterisation may cause the underlying pathogen to undergo sublimation so the surgeon may be at risk from inhaling it!

On my third day, there was a boy who had stabbed a pencil in his hand, a suspected stroke so the patient had a CT scan, a motorbike accident, two cases that needed debridement, someone with a second degree burn on her face and a child getting stitches on his head. Because we didn’t have many cases that afternoon, Dr. Chang taught us some suturing with the other 4th year nursing students. My patient:

IMG_3216

 

It was quite on our last day and I couldn’t really remember many cases because we went out later that night. What I do remember though is a surgery to remove an extra digit from a polydactyly patient – that was so interesting! I stayed around after to see a intervertebral disc replacement in the operating room (OR). It was performed by the same surgeon as the discectomy last week – apparently he’s also the best neurosurgeon in Chiang Mai! This time it involved the C5-C6 disc and the operation was performed anteriorly (rather than posteriorly last time). What fascinated me the most is that the disc was replaced with a cut-out skull of another person. Apparently they can also use bone from the patient’s pelvis for this procedure.

During the week, a few of us visited the orphanage again for one last time – this time I spent most of my time with the girls rather than the boys last week. I left them with a game, a translated letter and it was so hard to say goodbye. After the orphanage we went to a sky temple where there was a beautiful view of Chiang Mai. We also went to the night safari – in my opinion it was okay but not worth the 800 baht entrance fee. In fact there was a stray animal outside of the centre that we had more fun interacting with. During the week, there was this once-a-year- night market and my friend got me this cute as durian elephant for my birthday – it’s safe to say that I love it so much!

Orphanage:

 

Durian elephant:

IMG_3245

 

Cheers,
J

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