My 2nd and last clinic visit for this semester

3 03 2011

CASE #1

Today, I saw my first case of a real life patient in hypertensive crisis. It was quite bizarre as I thought the first half of the session was just to observe but we were basically tossed over there to do a physical examination instead to see what we could find.

The only thing that went on in my head was: “omg, please don’t crash on us while we’re doing the exam.” I even almost forgot everything we had to do, but finally pulled guts together and just did them.

The patient was sweating with pulmonary edema and suffering from respiratory problems. It was so difficult to get him to even sit up for a while.

“Make hurry, … I feel tired.”

BP 212/122. RR 28. pulse 90 and irregular. His  core temperature was elevated while the extremities were cold to the touch; even the forehead was cold.

The preceptor explained to us the difference between “urgent” and “emergent”. I did look it up afterward hypertensive crisis is when the diastolic bp is over 120. So, why is the patient just lying there without his Lasix diuretics treatment? When do they know to give it?

Anyhow, I was surprised how well I can detect pulse rhythms and listen for Grade 4 or 5 heart systolic heart murmurs now.

CASE #2.

Later, we interviewed a patient who was told that he had colon cancer by another doctor from another hospital. And then our second preceptor was under the impression that it might not be and maybe the patient was misled to believe that his multiple past injuries “caused his bowels to move”. Logically, this is not the right answer for colon cancer. You would need to have the HPNCC gene to get it and it’s more common to see in older patients.  Either way, that turned the story 180 degrees around for me because I don’t know what is truth anymore …. at least not until we run some investigations or test and do some more research.

Questions unanswered: Why can someone have 1/2 his colon remove at such a young age yet not require colostomy bag for life? And why was the colostomy bag put on one side when it usually goes on the other side? What color blood was in the stool? Did the medications cause the GI bleed?

wow … a lot we have yet to learn …

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