The Good, the Bad and the Ugly

The Good

Yesterday, we had an osce as a part of our annual evaluation. The exam had 12 stations (2 of them were rest). Stations included Research, ATLS, ACLS, Neurological Examination, EKGs, Slides (2 stations), Seizure, Drug Seeker Patient and Airway Management. Althogh the exam designing was good; but it seems the last year exam was better in content, designing and execution. The Good for the exam was its joint execution between our ED and Iran's.

 The Bad

The exam was a real pity for me. I did Bad in nearly all stations and the worst was EKGs.

The Ugly

It seems cheating is something in our blood and we can't live without it. In abstract some of us cheated yesterday. I think there were nothing more ugly than this.

* Pics: Corporate America's Good, Bad and the Ugly

a diasapointed one

Yesterday was my first shift in toxicology and quite disappointing.
Despite my expectations and hopes; there were an over crowded emergency without any educational benefit for me. Most of my patients were ingested benzodiazepines or intoxicated with ethanol and a smaller group were intoxicated with amphetamines, opioids etc. Since 10pm till 1am I had 22 patients, 3 of them comatose enough to be intubated. I just saw my patients, take a very brief history (Material? Amount? Time Taken? Emesis? Reason?) and a more brief Physical examinations (ABC + V/S + pupils + rarely neurologic examination) and write my orders rapidly. Not enough time to think, consult or even concentrate at my cases.
What make the shift harder was the act of EMS and other hospitals that send any addict patient with any presentation (mostly decreased LOC) to our ED.

My resume in this shift:
about 30-40 patients admitted
2 CPRs both with ROSC
5 Intubations

The educational note of my shif:
My compatriots are mostly addict or at least have someone addict in their family; interestingly Pour Methadon syroup or liqufied opium in refrigerator.

P.S. Tonight I'll be in my favorite ED again.

What an Abdominal Pain...

This 34 years old afghani worker came to ED with complaint of vague abdominal pain and constipation which were gradually developed in a week.
He didn't have any significant past history or drug history. His V/s was BP:130/90 PR:80 RR:26 OT:36.7 c.
In examination he has a soft abdomen without distension or tenderness, but found out that he has difficulty in walking or sitting. His neurologic examinations were normal except increased tone in all four extremities.
He was admitted in a non monitored ED bed.

my new blue scrub

After lots of delay we now have new scrubs in our ED.
Our new scrubs were supposed to be better than our olds but in my and many of my friends mind, they are not. Our main complaint is about the tight ugly colars, that are like female clothing.
Other problems include its color and the cloth itself (which contains a large amount of plastic fibers).

very HOT rumors

Yesterday I heard rumors about two residency exam preparing institute in Iran -Soroush-e-farzanegan and noandishan-e-arya- was shut down. The participants did not attend in classes yesterday and institutes declare that the situation will be cleared today.
Probably the shutting down is related to recent Iran's residency exam and the possibility of exam preparing institutes to cooperated with cheaters.

I searched the net but did not find anything about it yet.
I will glad to hear about it from anyone with more information.

Toxicology

 (pic: http://www.acmt.net/)

Today is my first day in toxicology service as a rotational resident. Toxicology was my favorite field for years and despite my favor is decreased recent years (as I get acquainted with a more interesting field -EM-), I really love it yet.

I'll spend my one month toxicology course in Loghman hospital, the main toxicology referral center in Iran, with EM residents from all over Iran. It has a nearly crowded ED; with toxicology cases that any EM resident wishes to see them.

This was my story; and what I have for you?

Here are useful toxicology & toxinology links:

emedicine- emergency medicine articles (toxics and toxins both involved)

Clinical Toxinology Resourses

TOXNET - Databases on toxicology, hazardous chemicals, environmental health, and toxic releases

any good link, you know? please comment me to add them

What's your Diagnosis?

Why me? Why here?

Hi dear readers
As the first post of this new blog, I want to describe why I decide to write a new blog this way, here.
I was a blogger in a crowded ED notes (the site is in Persian) ,my ED official blog, for nearly 1.5 years and I felt lucky be with them. Even I was its moderator for one year and I eagerly gave my place to one of my fellows 6 months earlier. But things did not do well with our weblog as my successor apply strict censorship and censor my and my colleagues posts and comments. So I decide to be parted with that blog and write in my own. I select writing in English this time so this blog can be read worldwide.