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Calls & Decision Making

Survived my 3-calls in 7 days craze. (3x36hrs calls)

Something very importantly we learned during calls were decision making, especially when MOs were not around and you have the whole ward/new admissions to yourself. It can be pretty daunting and scary which constantly sends chills down my spine. But over the time I learned to pick up crucial points. And when I look back retrospectively I am amazed by the important right decisions I made.

There was this girl who was admitted with auditory hallucination + bulimia + self harm + suicidal ideation (god knows why was she there but not IMH). After clerking a whole few pages of essay and I was making the plans for her, suddenly the HR strikes me. “52”. I asked the nurse to repeat it and it was 62.

“It’s normal lah…” the staff nurse commented.

My gut feeling told me that something wasn’t right and I have to take action. Hence I put her on cardiac monitoring as people with bulimia are at risk  of electrolyte imbalance and can fall into bradycardia pretty easily. KIV UECr/Ca/Mg/PO4. I went back to the ward and reviewed the case the next day and as what I expected, her HR went down to 39 lowest at night.

Another case was a 5 year old girl came in with pretreated pneumonia (with 5 doses of inadequate dose Amox),walking pneumonia hx, with very positive lung signs on examination and CXR, but clinically relatively well. +ve Adult contact! (mother had pneumonia and was on KLACID) I was like “this must be mycoplasma!!!” but my MO was like, ok let’s start high dose ampicillin cos her previous dose of Amox was inadequate. But later on towards the end he still said “ok i think we should start Klacid” … I rolled my eyes in my heart. Told ya.

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