ACCIDENTS AND EMERGENCIES 101

Welcome to A&E 101.
The accident and emergency  ward is the most important ward in the hospital. "first bus-stop when a patient arrives"

QUESTION
A 27 year old man was rushed into the A&E, he was involved in a RTA (road traffic accident), patient presented with bleeding to the left ear and a swollen left thigh and was semi-conscious.

Discuss the management of this patient.

MANAGEMENT
This is an emergency and the patient should be attended to immediately.
1.The basic ABC's (Airways, breathing and circulation)
2. A Glasgow coma scale should be performed immediately.
3. Check the blood pressure and control bleeding.
4. Set up an intravenous line infusing normal saline to avoid shock.
5. Set up another vein and take blood for baseline investigations ( full blood count, blood grouping and cross matching, packed cell volume, electrolyte/urea/creatinine, RVS (retro-viral screening) and urinalysis)
6. Insert a urinary catheter if the patient is unconscious
7. Specific investigations should be carried out. ( an X-ray of the head and neck(CT scan preferably), AP and Lateral x-ray of the left femur, x-ray of the hip joint)
8. Send an emergency consult to the surgical team.
9. Examine the 2 ears, examining from the right to the left.
10. Send an emergency consult to the ENT team (Ear, Nose and throat specialists)
11.When the patient is stabilized, take a good history from relatives or from him, Past medical history, drug history and allergies.

Thats all for now folks............
To be continued...
errrr, any questions????
cc @bumight @eneni @sexxydoc @docmurffy @ezzieb

REALITY CHECK ---- THE REAPER

For death is but a passing phase of Life;

A change of dress, a disrobing;

A birth into the unborn again;

A commencing where we ended;

A starting where we stopped to rest;

A crossroad of Eternity;

A giving up of something, to possess all things.

The end of the unreal, the beginning of the real.

EDWIN LEIBFREED, "The Song of the Soul"

“Somebody should tell us, right at the start of our lives, that we are dying. Then we might live life to the limit,

 every minute of every day. Do it! I say. Whatever you want to do, do it now! There are only so many tomorrows".

There is a time to be born and a time to die, just as Ecclesiastes said in his 3rd chapter in the holy bible and the characteristics of human beings "MR NIGER D " as we were taught in school, every living thing must die.

Those who think about death, carrying with them their existing ideas and emotions, usually assume that they will have, during their last hours, ideas and emotions of like vividness ... but they do not fully recognize the implication that the feeling faculty, too, is almost gone. The imagine the state to be one in which they can have emotions such as they now have on contemplating the cessation of life. But at the last all the mental powers simultaneously ebb, as do the bodily powers, and with them goes the capacity for emotion in general. It is, indeed, possible that in its last stages consciousness is occupied by a not displeasurable sense of rest.

It seems a strange and repugnant conclusion that with the cessation of consciousness at death, there ceases to be any knowledge of having existed. With his last breath it becomes to each the same thing as though he had never lived. And then the consciousness itself -- what is it during the time that it continues? And what becomes of it when it ends? We can only infer that it is a specialized and individualized form of that Infinite and Eternal Energy which transcends both our knowledge and our imagination; and that at death its elements lapse into the Infinite and Eternal Energy whence they were derived.

Death, is the reality we all run away from, it is inevitable and does not need to give a notice. What we do with our lives however is important. "live, love and learn" like my friend says "Ayanyinka Ayanlowo AKA Ayanyanks" Enjoy each moment and cherish them like treasures because you only have one life to live. Smile all you want, laugh all you can, do all the things that make you happy. The impact you have on the lives around you are but memories and they always linger. 

Death is not the greatest loss in life. The greatest loss is what dies inside us while we live.Have the courage to live, anyone can die. Though difficult, try not to sleep with pain, hate and disdain in your heart. Dont hesitate to show love to everyone around you, tell your friends and family how much you appreciate them because they need to know. it is painful if you loved someone dearly and you never got the chance to tell them when they were alive. I was having a conversation with a friend yesterday evening and he said "you better appreciate me now that i am alive o" i thought deeply and said to myself "this is the truth and reality"  

Finally, it is important to understand what grief is all about, and how to grief without hurting other people in the process. Grief is an important part of life just like death is. Grief is hard, it can be broken down into different stages and phases, the shock and denial, pain and guilt, anger and bargaining, depression, reflection and loneliness, the up-ward turn, reconstruction and working through and finally, acceptance and hope. 

Have a blessed day......

STOMACH ON THE RUN

Here i was, packing up and getting ready to round up my stay in Ile-ife, i stopped for some strange reason and decided on reading a few more topics in my obstetrics and gynecology notes. My belly starts to sing to my brain in a very unharmonious tune "hunger, e no get enemy o" i ignored this rantings and thought to read some more....

A knock came on my door and i was hesitant. In my head i thought, "who the hell is that right now? mscheeeew" oh it was my brother and he said "sis, u already packing up for lagos?" "yes o, as soon as we done with this exams am howdy".

Another knock came on the door and now i was confused, "who's at the door"i called out and then he says "Dr Moyo" and then i'm seriously wondering why he is visiting and who told him i lived here. He walks in with all the pride he must have and sits on my bed uninvited and there, my day was already going funny on me. i tried to be as nice as i could (cos i was obviously not in the entertaining mood) and asked if he wanted a drink.

I opened a bottle of red wine and handed him a glass. My brother and i shared a second glass simultaneously. We discussed topics and then Lagos parties (hmmmmn i didn't know he had it in him because i had perceived him to be some sort of geek and i wonder why. Maybe because he wore very funny looking recommended glasses).

The hunger song began again and this time we were talking about gastro-enteritis. My brother asked if i had eaten all day and i said no, my colleague immediately suggested "BUKA"( a place on the main campus i had heard about but never eaten from). I was glad they offered to bring me food but i was skeptical about the location, he persuaded me to try it out that it was wonderful and i finally succumbed and yes, they set out.

I was sincerely glad i was alone in my room again and continued some more reading while listening to music alongside, waiting for my food too. some hours later, they showed up, with 2 extra colleagues of ours and my steamy-hot food of fried-rice, jollof rice and fish. I could not eat it right away so we all laughed at funny jokes and revised some topics together and it was fun.

Finally, they all left and i loved the quiet once again. I took a nice shower and decided it was time to eat. Opening the food didn't give me much of an appetite but i knew i had to eat so i took some spoons and had a bottle of coke. I kept what was left of my meal and glanced through some more pages.

It was time to sleep, so i put up some tweets and decided to watch a movie on my laptop when it started, my stomach put up a worse tune "ojia, you have killed me o, O ti pa mi o "and i thought to myself, "this don't feel right"

I raced off to the toilet immediately, trying so hard to take a shit, but it just won't come. i had some water and some more water and tried so hard to concentrate on my movie. Finally i ran to the bathroom and threw out every single thing i had eaten, simultaneously using the toilet. Spending approximately #30 minutes in the bathroom, the episodes were over, gosh i felt drained and weak.

Thanking God i took a clean shower again and took 2 tablets of Immodium. what a night..........