30 Folie A Who? (2/2)

Xǔ Luli's 3rd year resident nodded.

Li Xiuying: ”C you should have used some initiative and got involved, in a high pressured situation you may get lost in the crowd.”

C nodded, she had just stood off to one side during the management this evening.

I will definitely do more next time. She clenched her fists.

Li Xiuying: ”D, you should have asked me if I preferred the ultrasound or echocardiogram machine, when carrying out a pericardiocentesis an ultrasound can be used continuously whilst inserting the needle it allows for more precision.”

D: ”Yes Dr. Li.”

Li Xiuying: ”Any questions about Xǔ Luli's management?”

C put up his hand : ”Dr. Li, why did you insert a nasogastric tube before carrying out the pericardiocentesis?”

Li Xiuying: ”Decompresses the stomach and decreases the risk of gastric perforation, advised if there is enough time.”

Li Xiuying: ”If there are no other question. Xǔ Enlai's 3rd year resident what did you do wrong?”

Xǔ Enlai's 3rd year resident: ”erm nothing.”

Li Xiuying raised an eyebrow. ”Nothing? You didn't speak to the patient, if you did he would have told you about the pain and burning sensation in his leg. You also didn't examine his leg thoroughly otherwise you would have noticed the signs of compartment syndrome.”

Li Xiuying: ”Come forward and right the 5 P's associated with compartment syndrome.”

Xǔ Enlai's 3rd year got up from his seat picked up the pen and started writing on the board.

He wrote pain, pallor, paresthesia, pulselessness and paralysis.

Li Xiuying: ”Now tick all that apply to the patient”

Xǔ Enlai's 3rd year hesitated: He ticked pain.

Li Xiuying: ” Tick all of them”

Xǔ Enlai's 3rd year's face was full of shame as he ticked all of the P's.

I should have checked properly, the patient could have lost his leg if the compartment syndrome wasn't noticed within 6 hours. He paled at the thought.

Li Xiuying: ”Do you still think you did nothing wrong?”

Xǔ Enlai's 3rd year shook his head from side to side : ”I'll always ensure I speak to the patient if they are conscious, I will also fully assess the patient for any other signs or symptoms and not just stop assessing after I find what I think is the most likely diagnosis.”

Li Xiuying nodded: ” E And F again like C you both need to be more involved. Any questions?”

F put up his hand: ”Dr. Li what method did you use for the patients dislocated shoulder?

Li Xiuying: ”Kocher's method. Any other questions?”

There was silence.

Li Xiuying: ”A, b and Xǔ Junjie's 3rd year you all had it easy as your patient was conscious and not distressed. But you all assumed that just because he wasn't complaining about pain he didn't have any. He had a broken collar bone and radius, do the three of you think that they aren't painful fractures? He should of at least had IV paracetamol and been prescribe PRN morphine sulfate ”

All three of them nodded.

Li Xiuying: ”4th year did you do anything wrong?

4th year: ”Erm, I'm not sure, I thought the surgery went well.”

Li Xiuying: ”The surgery wasn't the problem. You were bleeped for an emergency patient but you were late. You said you were with a patient which is even more disconcerting, considering your clothes were messy and buttons done up wrongly, there was also lipstick on your collar and your trouser zip was undone. so the reason for your lateness...”

Everyone in the room turned to him, some had looks of shock whilst other held expression of disdain.

How could he have an affair with a patient?!

The 4th year immediately paled: ”I lied, I lied I was with someone in the on call room but it wasn't a patient!”

Li Xiuying didn't spare him a second glance: ” Any questions about this patient?”

Li Xiuying: ”In the future everyone should make sure that they know which patients are coming in to the emergency department and anticipate the management and subsequently the equipment that may be needed.”

Li Xiuying spoke to the Qin's: ”I don't know where all the consultants or higher ranking doctors were tonight. They clearly exist because they were in the lecture hall the other day. Unless we were all suffering from a folie a deux?”

Everyone had confused looks on their faces.

Huh? Folie a who?

Little 4th looked at Li Xiuying in awe: ”Big sister YingYing you know how to speak french too?!”

Is there anything my big sister can't do?

Everyone: ”...”

That's not the point!