Blue Lights & Tea

Working as an emergency doctor (and now as a military reserve doctor) and facing the daily dilemmas of the A&E in the lovely city of London. This is about the little things that make me laugh, cry or smile as I go around London and in my slightly crazy life as an ER doctor, with a sprinkling of military medicine (or perhaps a cherry of trauma)! If all else fails - "Dance Monkey, Dance!"

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Merry Christmas everyone!!! All over the world!! Hugs to all medics fighting the good fight

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Looking after yourself makes sure you as an athlete can perform! These details are so important as the Sports Doctor!

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BASEM conference

Well I'm off to Liverpool the British Association of Sports and Exercise Medicine conference for the next 2 days so I will fill you in on any fab and interesting things I find out. It's been a very busy few weeks with lots of Sports med cover for rugby, tough Mudder and army stuff. Busy busy bee 🐝 How are you guys getting on?

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#home feels #cozy #autumncolors #autumn #rainyday #tea #october #sweaterweather #igersbucharest #ig_bucharest #ig_captures #huntgramromania #strangersinmyfeed #vwco #vscocam #vscocamphotos #vscogrid #vscogood #vscoonly #vscolove #vscoshot #vscophile #vscopeople #vscoism #instagramers #instadaily

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Autumn is here, it's cold and crispy walking to work this slightly wet London day.

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Sad alien face says "hello"! Wasn't expecting this little thing to be peeking out of a CT scan today 😂

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Good morning! Wheeee it’s Monday!

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Herkes kaybettiği kadar Çay içecekse eger; O masadan en son ben kalkarım…

Arzu Camgöz

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Morning all medical people 😊😊

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Today I learned...

Today we had a case presentation with the pulmonologist at the hospital and he presented a case from the early 1990′s that had imaging that looked like this. Apparently, before tuberculosis meds were available, tuberculosis was treated with plombage - surgically inserting lucite balls (or other foreign objects) into the pleural cavity in order to intentionally collapse the lung. The theory was it allowed the lung to heal quicker, or that the hypoxemia killed the TB, or maybe, that it would be a fun way to really baffle medical students 60 years later.

Image: http://www.nejm.org/doi/pdf/10.1056/NEJMicm0707466

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Lazy Sunday morning!

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Punctuality

I had a little chat recently with some of our new junior docs that have just rolled into their A&E rotation regarding punctuality. Though why we have to keep going on about this in this day and age I cannot understand. I cannot highlight this enough...... 0800 start time does not mean turn up at 0800. It means be changed and ready to go for handover at 0800. If your boss is there before you, you come in earlier to make sure you always beat them in. It is also disrespectful to the night team as it means they are then delayed with handover. If you think you might be running late, just call in and say so. I was trying to instill this golden nugget of info and I told them that they should be there 5 mins before (like the military do), otherwise the bosses will 100% notice who is late. What happened on our last night shift? 1 person was there prior to the boss, 5 mins prior to handover. This was the day reg. Every other doctor - SHO's and F2's as well as the F1's were late. Boss blew a fuse - the ones that go very quiet and steely are the ones you need to watch out for. Cue facepalm......

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The Cardiac Box: Meaningful For Gunshot Wounds?

A common dogma in trauma training is: “Watch out for the box!” This area on the anterior chest is purported to indicate high risk of cardiac injury in patients with penetrating trauma.

Where is it, exactly? Technically, it’s the zone extending from nipple to nipple, and from sternal notch to xiphoid.

But is the dogma true? A number of (old) papers mapped out the location and incidence of cardiac injury in stabs to the chest and upper abdomen. And there is a pretty good correlation. For stab wounds. But what about gunshots?

A team at Emory University ran a retrospective review of their trauma registry data over a three year period.

Here are the factoids:

They saw nearly 90 patients per year with penetrating chest wounds. Of these, 80% were gunshots (!) Many had more than one penetration.

Of the 233 gunshots inside “the box”, 34% injured the heart

The remaining 44 gunshots outside “the box” hit the heart 32% of the time

The authors suggest shifting the definition of “the box” toward the left, so that it extends from anterior midline, wraps around the left chest, and ends in the posterior midline (see below)

Bottom line: Here’s the problem. Knives are attached to a handle which tends to stay outside your patient. Thus, it can only go so deep. But a bullet will keep going until something stops it, or it runs out of gas. So it makes sense that the traditional boundaries of “the box” don’t apply. But extending it to include the left lateral chest and exclude everything on the right side? It may make statistical sense in this study, but common sense dictates that the trauma professional needs to think about the heart any time a gunshot goes anywhere near the chest or upper abdomen. Do not limit yourself to any “box!”

Reference: Redefining the cardiac box: evaluation of the relationship between thoracic gunshot wounds and cardiac injury. AAST 2016 Paper #12.

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A stimulating read on penetrating trauma.

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There are days when I feel I am heart! 😂 Post long shifts. Much love to #theawkwardyeti

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Hi! I'm in my 2nd year of medical school and on Friday's I shadow a doctor at the ER because I'm really interested in emergency medicine. Thing is, I have no clue of what book to refer to. I've had ALS/BLS but the class was on Sunday morning so I can't remember anything... Yesterday I was so embarrassed because I couldn't remember all the T's to check for in an unconscious trauma patient. Do you know of any ER guides online or a book you started out with? Thanks!!

Hi!Oooooo hate those questions but don't worry as loads of people forget in the heat of the moment. That's why they usually ask everyone in the team in an ALS scenario. Don't panic!The books I use are the Oxford handbook of emergency medicine, emergency medicine secrets and the lecture notes in emergency medicine.My ortho go to book is by McRae - orthopaedic management.Hope that helps?I will ask others on Monday what they use and let you know 😊😊

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What would you say you really love about your job/life/lifestyle etc :) And maybe what you don't love?

Hi!

Hmmm, what do I love and not love about my job? Good question.

Ok so I start off with what drives me insane/internally headbutt a wall.

- lack of awareness of the general public as to what actually constitutes an emergency. Having chest pain? Emergency. Ingrowing toe nail? Not an emergency.

- long shifts with no breaks

- constant interruptions

- priorities set to avoiding the 4 hour breach target

- the absolute lack of knowledge of the department of health on what we (in the NHS) actually do

- aggressive/racist/homophobes (we get alot of these people as when people come into hospital their polite society mask drops abit and you get to see the real them. Sometimes it’s not pleasant)

- this doesn’t drive me insane but it makes me sad; how your friends NOT working in the field of medicine cannot understand how you could possibly not be free every weekend.

And now for what I love about the job.

- my patients

- my ED team

- that we try against all odds sometimes to save a life

- the learning

- an amazing skill set!!

- the push to be better and improve as human beings

Now don’t get me wrong, the hours are long and sometimes I am so tired I can barely function. But in the grand scheme of things I keep going as it’s an amazing job and I get to see people at their worst and their best. Human beings really astound me every day.

Having a great team around you that supports and guides is what any job should have. If you know that they have your back, you can be confident in your actions.

I gave up surgery to do EM, while I miss the actual surgery, I feel I can do more and have a greater skill set in EM. You can take any EM doctor and drop them in any clinical situation anywhere in the world and we get to work. We are the Swiss Army knife of the medical world.

Lots look down on us, many have no idea what we do. Those that work with us, realise and appreciate it. But we don’t mind, we keep going doing what we can in the time we have. Just don’t call us Casualty doctors!

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Good morning!

[kvsgf]

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Morning all! Deep breath, here's to another shift.