Beargryllz Clinic

[Beargryllz]

2 yo white female presents with ear pain, worse on the right. Hx significant for >6 ear infections. Afebrile, playful, runs around the pediatric room decorated with fish and Disney princesses. No cough, no fatigue, no diarrhea, no vomiting, no change in appetite, no change in sleep pattern.

Blue foreign object visualized @ right ear canal on otoscopic exam

Dx: foreign body

Plan: remove foreign body

Case presented, consulted family medicine. Preceptor confirms foreign body, identifies ejected tympanostomy tube. My consultant consults ENT to do whatever it is they do with ejected tubes.

Nailed it

 

[Beargryllz]

3 yo white male presenting for annual exam. Talks, runs, feeds self with spoon and fork, mostly toilet trained, good vocabulary per mother, plays with siblings & peers at daycare, height ~80th percentile, weight ~50th percentile.

c/o seasonal allergies per mother. No vomiting, fever, diarrhea, ear pain, fatigue, or sickness in family. No tobacco users at home, lives with mom, dad, and 3 sisters.

Exam negative for wheezing, positive for mild-to-subclinical atopic dermatitis bilaterally @ elbows & knees. Patient denies itching.

Dx: eczema, allergic rhinitis

Plan: advised mother of options and expectations including worsening of symptoms, continue claritin for symptomatic rhinitis, advised topical steroid for symptomatic dermatitis only, follow up next year. Mother verbalizes understanding of expectations and management.

Later, kid

 

[gromit]

Are you in school?

 

[á´…eparted]

Have you decided to go into pediatrics or is this just part of your rotation?

This thread has a good chance of being very interesting .

 

[Beargryllz]

I'm in 3rd year, doing family medicine now. I do pediatrics later.

 

[Cloudpatrol]

Subscribed.

You deserve a TACO good sir!

 

[ceecee]

I started coding your reports. Then I stopped because it's my day off, no coding until tomorrow.

 

[Beargryllz]

I started doing surgery today

80ish y/o AA female seen today for left AKA (above-knee amputation). Hx for dementia, right AKA, diabetes, hyperlipidemia, peripheral artery disease, multiple non-healing ulcers on the left lower extremity. Currently living in nursing home.

I held the fleshy parts back so the real surgeon could cauterize and apply the bone saw thingy to the leg bone thingy. Site irrigated with saline and cefazolin. Then I used a staple gun to put the flappy flesh parts back together.

Next case was a 50 y/o white male presenting for almost the exact same thing except this one had a venous graft in place. Suspicious for thrombosis in the graft. His other leg had stents in place. This would be a last-ditch effort to save the grafted leg. So we put a graft on his graft so he could circulate while he circulates. This took a very long time and my hands started cramping awfully as I retracted the shit out of that surgical site.

What I learned is that it is way, way easier to simply cut the leg off than it is to try to open up the leg, sew blood vessel grafts together, and then put everything back in place. Being that I tend to be lazy and usually take the path of least resistance, it's a good thing I'm probably not going into surgery...

# of times I broke sterile field = 0

Goddamn I'm good