Tuesday, October 16, 2007

Final days of paediatrics

I know that I have been posting a lot about paediatrics. Truth be told, the rotation wasn't as bad as I made it out to be. Except when kids were crying, it was a decent experience.

Today I had a reasonable day, with two general surgery kids- one with appendicitis with an abscess, and another with Crohns with a new ileostomy. An ileostomy is an opening from the small bowel to the abdomen, which is used instead of the rectum to expel stool. It is managed through special appliances so it doesn't smell and most people with ostomies can live normal lives. Typically, the higher up the bowel you go, the more watery the stool is. This kid had one temporarily so that any fistulas (a connection between bowels that is not supposed to be there) he had due to Crohns would heal. It'll be a few months before they do surgery again to put everything back together again.

Working with general surgery patients can be quite busy. When you arrive on shift you are to do vitals and 0800 meds. This means you need to set up secondary lines to IV's if need be, or in my case with paediatrics, work with buretrols ( a secondary chamber where you can put medications into it). Next, after flushing that line, you need to assess your patient to make sure that the medications aren't causing interactions, do a full systemic assessment, and then get your patient up and out of their bed for their first walk. This all has to be done before first break, and if you're not a student, you have 4-5 patients, not just 2. Also, because they are a surgical patient, they typically have a bunch of drains and tubes in every orifice, which of course need to be inspected, drained, and monitored. You also need to get rid of the drainage and record how much fluid was lost.

While I was in general surgery for my adult acute care rotation, I didn't realize how much work I actually did compare to my classmates. I thought they were all doing as much work as I was. Now that I'm on a general floor in paediatrics, where kids are sick but not all surgical, I realize how much extra work those drains/tubes end up being. I'm not trying to say that my classmates didn't work hard, I'm sure they did, but it seems to me that general surgery cases tend to take a lot more time. I had general medicine cases the last few weeks, and I had time to go on breaks, and time to read the chart. Today, even though I have worked with general surgery cases before, and they were fairly straightforward cases, I barely had a chance to eat lunch.

If I don't get into ER for my 4 month practicum next term, I said I would do Gen Surg. I'm not 100% sure I'll like it, but it'll definitely give me a large amount of skills and efficiency with complex cases, so applying to the ER will be more successful later on.

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