Friday, January 05, 2007

Happy New Year

Although it is a little late.

I seem to have neglected blogging for far too long and yet I am not quite sure why. Maybe the current post I have is more demanding than the last, that is of course a very plausible reason as there are fewer staff in this department than in the last department I worked in. Or maybe I just haven't had anything interesting to say.

To be honest, I don't think anyone really reads this blog anymore. I am not as critically acclaimed or as witty as Dr. Crippen (NHS Blog Doctor) or any of the other medical related blogs out there. But I will endeavour to keep blogging, if only for my own sense of achievement.

The fiance is now in Iraq, doing his duty as an army medic whilst I am left here in the A&E department I am currently working in. I am becoming disillusioned with emergency medicine in my current post. This time last year I was working in a big city, now I am working in a town, not that it should make any difference. I quite enjoyed doing the menial A&E jobs such as simple suturing, removing splinters and other such tasks, but now I am apparently 'above' these jobs as I am a doctor, not a nurse practitioner. Granted some nurse practitioners do a splendid job, just not the work of one I saw yesterday.

Lee is a 20 year old lad who had got quite drunk on Tuesday night and had decided to jump off a wall whilst holding his bottle of beer. Now, as any normal person could have predicted, Lee didn't land smoothly and landed on the bottle of beer which lacerated his leg and arm. Luckily he was wearing jeans so the glass didn't go into his leg, or so he thought, but he did have some nasty cuts so he went to A&E. When he got there he was assessed by a nurse practitioner who cleaned the wounds and sutured them up and sent home with the instructions to get the sutures removed in 10 to 14 days. Lee presented at A&E again yesterday where I saw him. The sutures in his leg were extremely red and swollen, clearly infected, although they were undoubtedly very, very neat, much neater than I suture. I questioned him to see what treatment he had received and was shocked to hear that his wounds hadn't been X-rayed to see if any glss was in the wounds. I sent him down to X-ray and lo and behold he had 3 small shards of glass in the wound. I took out the old stitches and under local anaesthetic explored the wound to find the glass, which I did, I then sent him back to X-ray to ensure I had removed all the glass and resutured his wound, with the aid of steri-strips as the skin wasn't holding after being previously sutured.

This took extra time, but should have been done in the first place. One of the first rules of A&E medicine that I learnt was that if a penetrating or lacerating injury had been made with broken glass then the wound had to be X-rayed to ensure there was no glass left under the skin. Clearly this pearl of wisdom hasn't been passed onto our dear nurse practitioners.


Anonymous said...

i check your blog weekly in the hope of updates. i'm delighted u r blogging again.

Jo said...

Hello! I check your blog from time to time - discovered it sometime in November - glad you're back. Please stay :)

Anonymous said...

Good to see you back, I check regularly too.

Anonymous said...

My goodness, that's shocking.

I helped out at the College of Emergency Medicine at the FCEM OSCEs on the suturing station, and ALL of the A&E registrars stated that they would ensure the wound was a clean one, i.e. there were no pieces of shrapnel inside etc...

My goodness. She sewed him up with glass still inside. Egad.