Q: How can the location of a patient’s pregnancy and the fetal heart rate be detected? How can we rule out an ectopic pregnancy?
A: A type of pelvic ultrasound, called a transabdominal ultrasound, is conducted in order to scan the lower abdomen. This less invasive method allows the physician to examine the bladder (appears as a large black circle), the uterus with endometrium thickening, the cervix, fallopian tubes, and ovaries (appear as chocolate chip cookies). This ultrasound can also show bowel movements and usually detects a fetal heart rate. An intrauterine pregnancy (IUP) can be confirmed with a gestation sac located within the uterus and a fetal heart rate, but the patient must be at least 6 weeks pregnant. Physicians are most concerned with the presence of fluid, which can denote an ectopic pregnancy. An ectopic pregnancy is when the fetus develops outside of the uterus, typically in the fallopian tube, and can cause extensive internal bleeding by rupturing the fallopian tube. This condition puts both the mother and the fetus at risk, thus it must be diagnosed and treated rapidly.
Case: A patient at 10 weeks gestation presented in the Yellow Team with slight pelvic pain. A transabdominal ultrasound was conducted to verify an intrauterine pregnancy (IUP). The ultrasound image showed a yolk sac within the uterus which is typical at 10 weeks gestation. However, a fetal heart rate wasn’t detected. There was no fluid present that could point towards an ectopic pregnancy. The ultrasound was also unable to locate the ovaries, so another proper ultrasound was ordered to confirm an IUP.
When asking an asthma patient what they would do if their asthma got worse, they replied by saying they’d take deep breaths and drink water. I notified the patient it would actually be best to use the reliever medication, or go to the ER if symptoms worsened. Also, the patient thought asthma affected the chest, and not the lungs. Hearing the patient’s responses made me realize how vital our Asthma Action Plan study is. Most patients are unaware of the fact that there are different inhaler medications used for different circumstances, nor do they know how to use the inhaler properly. I think physicians should make an effort to provide all asthma patients with a sheet similar to the asthma education sheet when first diagnosing the patient. It can circumvent later problems that arise from the patient not knowing what asthma actually is or how to control it. Being aware of what asthma is and what medications to use in certain situations can make the patient feel more in control of their asthma, rather than the asthma controlling them.
Samantha, Iman, and I approached a patient for the Health Literacy project. I gave a brief overview of the study, but I noticed the patient began clutching their stomach tightly and made sounds of pain. It was evident the pain (most likely epigastric pain) was hindering their ability to comprehend what I was saying. I decided it was best not to worry about the study at this moment since they were in extreme discomfort, and thanked them for their time. The patient apologized but nodded and agreed this was best. I think the Health Literacy project is one of the more challenging projects due to the various scenarios that can play out while enrolling a patient. Due to this, it’s best to stick to your gut and try to get an understanding of the patient’s mood when giving a synopsis of the study. Hopefully over time I can become more confident in my patient interaction abilities and how to assess a situation more rapidly.
I haven’t had the chance to speak to many gun shot victims, but there was one patient I spoke to who didn’t hesitate to share their story. The patient was shot in the upper extremity (right arm) while taking care of their kids. The patient quickly denied that social media played a role in instigating the gun shot since they rarely went on their phone. While explaining the story, the patient explained how they were walking to their niece’s house and there was a man on the same block yelling, who eventually pulled out a gun and shot the patient in the arm. Rather than screaming and calling for help, the patient calmly went inside of the house to call the police so as not to alarm the children. I found this very surprising and a bit startling, because getting shot in the arm seems extremely painful. Yet, the patient kept their emotions under control for the sake of the kids. This seems like an unfortunate case of being at the wrong place at the wrong time.
This past month I’ve worked extensively on the HEARTScore project due to the time frame of my shift. Since I tend to come in 2 pm – 5 pm, I haven’t had as much patient interaction compared to the morning shifts. However, working on the HEARTScore Retrospective Study has still been a wonderful learning experience for me since I’ve become more comfortable with deciphering the clinical notes. Usually I’ll come across abbreviations or medical terms I’m unaware of, which prompts me to do a bit of background research to garner a better understanding of the terms. For example, “normocephalic atraumatic” essentially means that a patient’s head is in good working condition and hasn’t suffered any damage. Another term I came across is “NBNB vomiting,” which stands for “nonbilious vomiting.” This type of vomiting involves regular forward flow in the intestinal tract and omits bile/gastric content from the vomit. Moreover, I came across the term “syncope,” which is another word for fainting due to the lack of oxygen flow to the brain, perhaps due to a drop in blood pressure. There are other simple abbreviations I’m becoming familiar with, such as “HPI” (history of present illness) and “PMH” (past medical history). Overall, I hope to continue making a list of new vocabulary terms and abbreviations I find while reading through the notes, and I’ve found that I actually enjoy doing my own background research.
Karen F. Murray, Dennis L. Christie Pediatrics in Review Oct 1998, 19 (10) 337-341; DOI: 10.1542/pir.19-10-337
Nordqvist, C. (2017, December 01). What is fainting and what causes it? Retrieved September 30, 2018, from https://www.medicalnewstoday.com/articles/182524.php
What Is Normocephalic Atraumatic. (n.d.). Retrieved September 30, 2018, from http://www.healthforus.info/what-is-normocephalic-atraumatic-definition/ (more…)