6 August, 2014
Don’t you hate it when you have unsatisfying visits? Like when there is no clear diagnosis or you just feel inadequate as a health care provider?
I had two of those yesterday.
23 July, 2014
I finally had a couple of good days here at the clinic. I was busy with patients and got to keep up with my skills doing some procedures. We were down on providers so I got the opportunity to triage some kids. The first kids I triaged were school-aged siblings. Whenever siblings come in sick, it’s often viral. I usually ask who got sick first and go from there. Never let a parent talk about both kids at the same time- you will get confused. So I do a full history for one kid, then the other. Both seemed fine, but the older brother had a stomach ache so I did a urine test. The dip showed some trace glucose and protein. Now I’ve heard that trace protein during illness is common, but I had not heard of glucose in the urine meaning the same thing. The pediatrician saw him and his fingerstick was fine, so that was a lesson learned.
I also saw a 12 mth old with 3 days of high fever with a temp of 103 in clinic. Parents get very nervous about fever, but it’s no big deal. Fever is just the body doing its job. The problem is having a nonverbal patient with fever and no other symptoms. I wanted to blame the fever on a virus, but without cough, vomiting, diarrhea, or rash, the diagnosis becomes harder. If this was the ER, we might immediately do a urine cath, blood work, and possibly a lumbar puncture to find the source of infection. However, working in outpatient is more forgiving. You can bring the patient back the next day and keep a close watch on them. In her case, she was well hydrated with good energy, so waiting another day was a good option. I was thinking this looked like Roseola. Roseola is tricky because the patient initially presents with high fever and no other symptoms. After 4-5 days the fever breaks and they get a full body rash. I called the next day and the fever had broken, but no rash. Looks like another case of mysterious teething-baby virus. It’s amazing how little we know.
I also got to help out in the lab doing blood draws. Before starting this job I didn’t know how to do blood draws or urine caths. I was lucky to have a great teacher- a long-time medical assistant with crazy skill. I had an obese teenager that needed a blood draw and I could feel a deep vein in the antecubital fossa. I’m usually more comfortable with the superficial veins, but I took on the challenge and got it! It’s the small successes like that, that keep me going.