first day of emed and it's been quite a day. had the usual briefing, signing of forms and lectures in the morning, before starting our attachment to the resus room. when we entered the room, the doctors had just called it on one patient. then a second patient was wheeled in two trolleys away, a 49/I/M with esrf and rejected dialysis who suddenly had a fit at a coffee shop. was asystole when he was brought in, but they eventually got him stabilized. he never did quite wake up after that and was breathing only with the help of the respirator, so his family was informed about the situation. they understood, and i think the doctors intended to extubate him later, but he died before that.

third patient we saw was a nice chinese gentleman who actually was an outpatient here at the western hospital. after a routine follow-up blood test this morning, he was told to come back because his potassium was nearly 7. he was quite well, and we chatted with him for a bit. then suddenly he started to develop some chest "tightness", which progressed to pain. the nurse did an ecg, and guess what? st depressions in v3 and v4. like, wow, right in front of our eyes! some morphine, gtn and aspirin later, he was a little better. told him to please inform the doctors if he felt any discomfort anywhere, because if we hadn't been talking to him, he wouldn't have mentioned that he was having chest pain!

)edited)

death in the emergency department is more unpleasant and sad than in the wards, simply because most of it happens when you least expect it. if there's an elderly lady who's got pneumonia and a host of other co-morbids, the family is prepared for the eventuality. no one ever expected that indian gentleman to go into asystole. it's the suddeness of it all which upset me for a while after i had left the hospital, perhaps because i've been through something like this. i guess we all must get used to it, but do we?