Day 3 atas panggilan (on-call)

Hmmmm......still feel fairly incompetent. Not cryingly incompetent, but a quiet desperate hum in the background that's a buzzing that indicates im not exactky sure what is going on.

That just sounds like me everyday of my life.

So, the moral of the day:

1. GP patient summaries are useless. Try calling NOK if any doubt, but it's hard. Hard hard. Confused little ladies are tough.

2. Look up: criteria to CT head.

3. Risk factors for PE and well's score. Virchow's triad: hypercoagubility, stasis and vessel injury. + PMH of DVT or PE
   Well's score (thanks wiki)

• clinically suspected DVT - 3.0 points
• alternative diagnosis is less likely than PE - 3.0 points
• tachycardia - 1.5 points
• immobilization/surgery in previous four weeks - 1.5 points
• history of DVT or PE - 1.5 points
• hemoptysis - 1.0 points
• malignancy (treatment for within 6 months, palliative) - 1.0 points

Traditional interpretation^[5][6][11]

• Score >6.0 - High (probability 59% based on pooled data^[12])
• Score 2.0 to 6.0 - Moderate (probability 29% based on pooled data^[12])
• Score <2.0 - Low (probability 15% based on pooled data^[12])

Alternate interpretation^[5][8]

• Score > 4 - PE likely. Consider diagnostic imaging.
• Score 4 or less - PE unlikely. Consider D-dimer to rule out PE.

Scoring system for DVT

1. Active cancer (treatment within last 6 months or palliative) -- 1 point
2. Calf swelling >3 cm compared to other calf (measured 10 cm below tibial tuberosity) -- 1 point
3. Collateral superficial veins (non-varicose) -- 1 point
4. Pitting edema (confined to symptomatic leg) -- 1 point
5. Swelling of entire leg - 1 point
6. Localized pain along distribution of deep venous system—1 point
7. Paralysis, paresis, or recent cast immobilization of lower extremities—1 point
8. Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 4 weeks—1 point
9. Previous documented DVT-1 point.
10. Alternative diagnosis at least as likely—Subtract 2 points

4. Heart failure- diagnosis and treament.

5. Cellulitis- criteria for IV abx.

6. Must carry spare pens on person. Had emergency of no pens with a consultant. Im so blond.

7. Must make a point to drink water and have a biccie after each long clerking. If i didn't wish i was dead so much i'd wish i was a robot. Being human is tres difficile.