A case of a girl with stomach pain…

Stomach pain -or as they are medically known – abdominal pain is a very common complaint and one that almost all of us must have had at some point in our lives. There are many kinds of stomach pains. We can categorise them based on how they feel: eg. dull, sharp, burning, crampy. We can do one better and categorise them on location: upper abdominal, lower abdominal, right upper, left lower. We can even categorise them based on how long the pain has been there for: seconds? Minutes? Days? Years!? By doing this we can already start to form what sorts of things are probably going wrong in the abdominal area. This is called a focussed history taking of a patient. Not that I’m an expert but I’m going to attempt to discuss a particular case of a woman with abdominal pain and through that case, hopefully highlight to you how important a good history is.

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Crash call! All hands on deck

In the hospital, crash call alarms are the single alarm that you both dread and look forward to. It’s the one time doctors and nurses (and anyone who is available) get closest to being a paramedic. On one hand its terrible because a crash call means that something bad has happened to a patient for which ALL HANDS ON DECK are needed to get that patient back to a stable state. And that’s sad. Because the patient is sick. However it’s also adrenaline rush inducing. The atmosphere of the whole ward changes. Everyone is focussed on the patient. From the most juniour members (us medical students) to the nurses and juniour doctors, right up to the consultant. There is something for every body to do.

Today morning, a crash call alarm went off on the ward I was on. We were in the middle of a ward round and suddenly the two doctors around me and a bunch of nurses ran to the place where the alarm was coming from. I, along with the other two medical students, rushed along too. From the peripheries I could just make out that the patient was on the floor – not responding. The doctors and nurses worked together in a calm yet fast manner to get bloods, a cannula in and IV access. The patient’s vital signs (blood pressure, temperature, blood glucose levels, heart rate and respiratory rate). were all normal This was important to check because people don’t just fall down and loose consciousness for no reason! I helped too by running to the labs with the blood to check for any abnormalities.

Whilst this was all going on, the rest of the patients in the ward had to also be looked at. Normally on a ward round in hospitals, you have a few doctors checking each patient, every day. Well today, the crash call meant that only the consultant was available to carry on. I went along with the consultant – intending to help with small things like getting the curtains around the bed, opening up the observation charts and holding the notes. The actual doctoring part, I normally leave to the professionals. But we were low on doctors and that meant I had to write the patient notes myself (DISCLAIMER: This was obviously checked and signed off by the consultant!).

It certainly was an interesting morning…and just made me appreciate how unpredictable working in a hospital is!