A Hard Night

"The successful warrior is the average man with laser focus."- Bruce Lee

During our last call, I was able to clerk an elderly man who presented to Accident and Emergency due to loss of consciousness for one day, hiccups and complaints of left knee pain for a week. Long story short, his presentation of community acquired pneumonia and dehydration resolved however his hiccups were so persistent that sadly he left with them.

We did our best to try and treat the hiccups; first ordering Metoclopramide which seemed to do nothing so we discontinued that and the intern on call decided to switch him to Largactil.

Boy did I have a surprise the next morning when I went to SOAP him. He was drowsy, barely opened his eyes the whole time that I was there and no longer oriented to place.

After my failed attempts at waking him up,  and being rowed by him since he was convinced he spent the night on another island and was in desperate need of sleep, I took it upon myself to read the notes and orders and looked up the drugs that he was on that I was not familiar with.

Thanks to my handy-dandy Medscape app on my smartphone, I along with another SHO was able to find out that one of the most common side effects of Largactil is drowsiness and unfortunately for him, it didn't help that rather than starting him on 10mg of the drug he was started on 25mg.

Needless to say, we discontinued the Largactil after our morning rounds with the Consultant and sure enough he was back to his flirtatious, alert self again, anxious to return to the island to his wife.

This rotation has made me realize the importance of firstly taking a good history, paying attention to every detail and scrutinizing anything that may make your eyebrows raise.

At the end of the day, overlooking one small detail can be vital in the proper management and care of a patient. As a student it helps to question certain decisions when it comes to management especially if you've had the time to read up on management and care of your patients condition. I urge you to make it a habit early on especially if Internal Medicine is your next rotation as it will assist you throughout the course of clinical rotations especially as you study for your examinations.

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