Saturday, April 16, 2011

Circadian rhythms

I'm not sure what computer program is used for writing schedules here, but please, Yaron, don't ever use it! If you really want to mess up somebody's circadian rhythms, you couldn't do it better than the scheduling here - routinely late evenings are followed by early evening followed by days. Thank goodness there are no nights for the consultants.

And, who cares what the coverage actually is? Supposed to be double and triple consultant coverage during the afternoon and evening with the last consultant (we'd call him and attending) leaving at midnight. But, if it's a bit inconvenient, single coverage is fine. Or, the last consultant can leave at 10 and the registrars can just suck it up for 10 hours instead of 8 hours. And, if there are some meetings for the consultant to go to (because he's the only permanent guy on staff) he can just wander off for a few hours, and the registrar can deal with whatever.

80 year old lady found in her home (after a few days of worsening headaches) obtunded, complaining of headache, vomiting, and at the rural hospital found to have bit of an elevated troponin. She woke up and the headache went away at the hospital, and some hours later she arrived at our place. Felt fine. Trop 0.8. Gotta be carbon monoxide. But, heat pump, electric water heater, no wood stove. (Forgot to ask about paint strippers.) I didn't hear about her until 8 or more hours after she was removed from her house, and the intern didn't understand how to order a carboxyhemoglogin, so we still didn't have a level reported when I left for the night and it's likely to be back to normal by then anyway. But, since they seem to use Non-Rebreather Masks for everything here - rather than nasal prongs - she'd been on high flow oxygen for a long time anyway - so had been treated. So, the medical team will probably muck about for a while and send her home with no diagnosis, and she'll strip some more paint off old furniture, or the neighbor will leave the truck running next to her window, or whatever the unidentified source is and her GP will treat her for migraines. Khe Garne. (For Drew: that case is from Strahan - really, do you pronounce it"strawn"? - no wonder people looked at me funny when I was there 2 weeks ago and pronounced it: "Stray-han".)

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