Morning guys. I'm Siobhan, a second year medical resident. I just got to the hospital and
today you are gonna be joining me for a typical day on the internal medicine service.
So I didn't have any pages between 8:30 p.m. and
like 5:00 in the morning, so I had like a period of like 8 hours or so without any pages.
I actually thought that both pagers weren't working, but then thankfully at about 5:00 a.m. they started going off again.
Every morning I start by assigning each patient to a member of the medical team.
They will be responsible for seeing the patient, examining them and coming up with a plan that they'll then review with me and
the attending physician.
Alright, so now I'm heading down to the emergency department to meet up with the attending physician on my team,
so my supervisor and we'll be seeing all the new patients that got admitted overnight together.
I get to make a plan, I do physical exam and I get that all reviewed by my staff.
So it's a phenomenal learning opportunity for me.
Heading back upstairs now.
So one of the patients that we got was very sick when they came into the
emergency department and they were diagnosed with something called DKA, so that's diabetic ketoacidosis.
People with type 1 diabetes are not able to produce insulin,
which is a very important hormone that helps regulate glucose, your blood sugar.
Without insulin, cells can't use glucose as energy.
Instead they rely on the breakdown of fat into ketones, which actually makes the blood acidic.
Since your cells aren't using glucose properly, the kidneys pee out extra sugar, making the person very very
dehydrated.
So that's how patients with DKA come to the hospital with very high sugars, ketones and acidic blood.
To reverse this we treat patients with IV insulin and tons of fluid to correct their dehydration.
Alright, so it's time to look over the morning blood work for all 30 patients on our team and
then I'm going to focus on the 3 that we're planning to discharge today.
Hi, can you please page GI? Thank you.
Hey, this is Siobhan from team C medicine.
Right, thank you so much for calling back.
So we've got a patient here with liver disease.
It's had this significant drop in their hemoglobin and they've been having melina.
So we're hoping that you'd be able to take a look and see and consider maybe even scoping as an inpatient.
Great. Thanks so much, okay. Bye.
Alright, heading for our noon hour teaching now.
We have pre-code sessions,
which means we do simulations of patients who are very sick on the ward.
And as if the medical student was called,
they start up doing what they can. Then they'll call the junior resident
and then finally I'll get called, the senior resident. And you're trying to do this real-time, what you would actually do.
So it's exciting, it's really good learning actually.
Okay, teaching is done now.
So my plan is to head down to the emergency department
and follow up on that patient with DKA, as well as some... There are new
patients who got admitted to hospital. When they are more recently admitted, things have been faster and you want to actually track their progress.
So seeing them multiple times a day is usually a good idea.
Hey, you got a moment?
Yeah, what's up? Do you know patient number 27? .
Ehhh... Yeah yeah yeah. He's having increased pain. He has the bilateral hip ulcers. Oh, yeah.
He's been complaining of more pain than usual. Do you think we could perhaps take a look before they are dressed up? Oh, they are open now?
Yeah, they are open right now. Has he been having fevers or anything? No, he sees afebrile. Yeah, okay. Let's do that.
Okay, so our patient with DKA is getting blood work every two hours. They are getting their sugars checked every two hours.
So let's just trend them, see how it's doing on the computer and we may have to switch up some of their medications,
depending on what we find.
Okay, just getting set up for a family meeting. Ehm, they'll be in this room in a couple of minutes. We often do this
with patients and their families, sometimes together and to give a medical update about what's been happening in hospital.
But also there are times when patients require more services, more support than they'd acquired before they came into the hospital.
So in this particular case
we're going to be discussing options of either giving more supports at home for this patient
or if they're gonna need to be start thinking about things like retirement home or long-term care.
Which I think is sometimes very very difficult to start that conversation,
but it's also rewarding, it's about safety at home.
Okay, 3:00 p.m. now,
so we're heading to meet up with the team and
review all the patients seen for the day and hopefully tidy things up, so people go home.
Hey guys.
Ready to review if you've had a chance to see all your patients. Yeah. Awesome. Okay, perfect. Okay, so 5 p.m. now.
Nikola, you're on call tonight. Yeah. So you're gonna be holding down the team.
Well, of course I have the doctors.
Yes, there's a staff on tonight who's gonna be helping out. And we're just gonna go and hand over to that staff
about any issues to follow up on tonight.
Thought I was done for the day, but a patient is having trouble in terms of their discharge.
Anyway, I can't really go into the details of it. But I need to go up and try to sort this out,
so it's not all on be the night time person, because that's not really fair and they don't know the patient, so
Hopefully this will be fast.
Oh, just about 6 p.m.
Finally done.
Although actually,
I just want to pop in one more time on that patient with DKA in the emergency department.
Patient was quite sick today and just makes me feel better when I'm going home.
Alright, so the patient's doing well and the resident overnight is totally aware of this patient, so I feel very comfortable going home now.
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don't forget to subscribe and take a look at some of these videos over here for something similar.
Otherwise, I'll be chatting with you guys next week. So bye for now!