On the 4th overnight shift
Name: TSCD
Age: 26
Difficult historian - slurred, incoherent speech.
Presenting complaint: Headache associated with photophobia
Examination:
Drowsy but rousable.
Appeared tired and pale.
Inappropriate affect eg giggles when discussing serious problems.
Disoriented in time and place.
Abbreviated mental test score: 6/10 (not able to give correct date/time, identify British Monarch or count backwards)
Diagnosis: Acute confusional state - ?stroke ?meningitis
Plan:
1. Continue overnight shifts (9pm to 10am) for another 3 days
2. Start morning ward round at 6am and continue until noon
3. Insist that patient arrive early to attend evening ward round at 8pm as well
4. Start up caffiene infusion as required
5. GPs to please send in as many agitated and aggressive patients as possible
Age: 26
Difficult historian - slurred, incoherent speech.
Presenting complaint: Headache associated with photophobia
Examination:
Drowsy but rousable.
Appeared tired and pale.
Inappropriate affect eg giggles when discussing serious problems.
Disoriented in time and place.
Abbreviated mental test score: 6/10 (not able to give correct date/time, identify British Monarch or count backwards)
Diagnosis: Acute confusional state - ?stroke ?meningitis
Plan:
1. Continue overnight shifts (9pm to 10am) for another 3 days
2. Start morning ward round at 6am and continue until noon
3. Insist that patient arrive early to attend evening ward round at 8pm as well
4. Start up caffiene infusion as required
5. GPs to please send in as many agitated and aggressive patients as possible
posted by tscd at 1:16 pm
6 Comments:
I thought you are much older than 26. :) A surprise, really.
takchek: Really? How old do you think I am? Do I sound jaded in my posts or something?
Maybe...I assumed you are in your 30s. :) Hmmpf, younger than me and already married.
Oh, you are having it quite bad...
positive positive... cheer yourself up ya! every little thing counts. :)
(I thought you are 32 or something :P)
oh dear. N.A.P is NEEDED. at the very least.
Caffeine gives me arthritis. If I want to be awake at night, I have to actually be awake.
If you work 2nd shift, then Sunlight will precede you. When it follows, you, it's too late, right?
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