CME in ED

Yea....no Morning teaching session today...so don't have to wake up in the morning for 8am teaching session. Just sleep till late morning and wait for PM shift at 3 pm....

It's nice to wake up naturally in the late morning.
Actually Morning teaching session is not a bad thing though........
We have this session 3 times a week, wednesday, thursday and Saturday, all started by an ED specialist Dr. Ch. But this weekend he's flying to Miri so this Saturday's teaching session was canceled.

Everytime during teaching session, we all get to discuss many interesting cases, and also about what can we miss out in a patient came in with just a simple complain.
Also ED specialists sharing their old times experiences and stories.

The last teaching session, we were discussing about antivenom. Why do we have delay in antivenom treatment sometime? What's the factors?
Our experienced ED HOD, told us by his experience and came out with 4 factors:

1) Unaware of what happen to the patient as patient came in unconscious....All the vitals crushed down, without knowing the source, then was sent to the ward, noted there's fangs sign on patient.Only then we know the cause of the shock.......

2) No antivenom available in disctrict hospital. A patient died of snake bite because no antivenom available. So, we are advised to always check for the antivenom availability in district hospital.

3) We do not know when to give the antivenom, what's the indication for antivenom.

4) Giving a wrong antivenom. A case happened that patient with snake bite died because of wrong antivenom given. The bottle looks like antivenom, name was almost the same too, but actually it was actually not antivenom. So make sure we give the correct antivenom/ read properly the bottle's label before administering to patient.

Some interesting and scary cases shared by fellow ED colleagues during the teaching session:
1) Patient presented with periumbilical pain, then collapsed. ECG showed sinus rhythm to ED doctors and also the medical team. The next day, when the physician came and saw the ECG, he said that might be a MI. So, did another ECG, and true enough, it shows MI changes. But, eventually patient died of cardiogenic shock.
Was my friend's case, too bad she didnt took that ECG picture and show to us what went wrong with 'normal looking' ECG which ended up as MI changes. Gonna find that out later on.

2) An abdominal pain green zone patient, eventually turn out to be triple AAA.

3) A colleague who was a Day 3 HO last time in his first posting in Medical department, was asked to escort a so called "stable" intubated patient to Timberland for a CTB. THat time he was quite free, thus was asked to escort the patient. But, that patient later on asystole at Timberland main door, before went in for CTB. He got panic, called physician, who asked him to called the Timberland physician for help as that physician wasn't at the scene. So then, he called the Timberland physician for help. Resus was successful and patient got the CTB done and return back to SGH. What an eventful day for a Day 3 HO.

And many more cases discussed during teaching session.

Indeed, teaching sessions are fun, everyone get to voice out their own opinion and share their scary and yet interesting cases, but sometimes it felt like time dragging for the PM shift people and the post night ppl cause they have to go to hospital twice a day and the post night ppl cant get back to rest early.
It's enjoying for the double shift and morning shift ppl cause they get to relax during the working hour.

Anyway, it's still fun working in ED aka "A + E Department" aka "All + Everything Department".