Hey guys. I’m Siobhan, a second year medical resident. I’m just starting a night shift, so tonight I am the senior resident in charge of a team of junior first year medical residents as well as medical students. So let’s see what the night is gonna bring. Hey. Oooh, take it! Oh my gosh, hahaha. Okay, was the day that bad? Was it busy? Okay, oh no. I can’t. Hi, this is Siobhan the SMR returning a page. Ah yeah. How low is the sodium? Okay, yeah. Do you mind just sending off urine lytes and then we’ll be there in the next 30 minutes or so. Perfect, great. Thanks so much. Okay, bye. When the emergency physician consults internal medicine to see a patient, it’s usually because they feel the patient needs to be admitted to the hospital. So I’ll go and see the patient first and depending how sick they are or how complicated the case is, I’ll assign either a medical student or a first year resident to do the consult. Then when they’re done, they’ll come and review their work with me. Hypertension and dyslipidemia, 2 prior strokes with similar episodes. She’s being treated with apixaban reduced dose 2.5 milligrams via IV. Hello. Hey. How is it going? Good, how are you? Good, is everything okay? Yeah, it’s not too bad yet. I have a consult for you. Okay. So I have a 75 year old lady and with no past medical history who came in tonight with chest pain. The chest pain has been retrosternal. It’s been on and off for about the past seven to ten days. It gets worse with exertion, associated with shortness of breath, nausea, radiates a bit to her back, vitals are all fine, ECG is unremarkable. The reason she came in today is that when it initially started, it was only happening 2 to 3 times a day, it’s now happening about 7 to 8 times a day. And with even fairly limited exertion, like going up the stairs or just doing something like light housework. ECG is normal, tropes are negative times two, but certainly concerning for angina. I hope you can see her. Absolutely no problem, thanks very much. Angina is chest pain caused by narrowing in the blood vessels of the heart. Based on the patients age and symptoms, it sounds like unstable angina and she’s at increased risk of having a heart attack. So we’re admitting her to the hospital, starting blood thinners and asking cardiology to see her in the morning to consider an angiogram. That’s when they actually go into the blood vessels of the heart and look for a blockage. Hi, this is Siobhan the SMR returning a page. Yep sure, no problem. Okay. We’ll be there to see her soon. Thanks, bye. The emergency physician has asked us to see an elderly patient who fainted. Lots of things can cause fainting, but my first concern is whether it’s related to the heart, like an abnormal heart rhythm or a problem with the valve. Although in this case I think it’s more related to the patient being dehydrated, which we can easily fix with IV fluids. Hey Lana. Hello. You’re ready to review? For sure. Okay, so guys, this is Lana. She’s a PA student. So physician assistant, a student and is finishing up in a couple of months. So very exciting. Yeah, for sure. And you saw our patient with syncope, right? Right. Yeah. So we have a 75 year old male who presented with syncope and he has a history of heart failure as well as dyslipidemia, hypertension. Oh 12:30, I’m so hungry. I feel like my brain can’t function, my breath is definitely bad. Too much information! Ok, let’s go to the cafeteria. Okay, mission accomplished. And I got snacks for the whole team here too. Gotta get some encouragement for all the new consults coming in. Okay, well keep me updated and let me know how she’s doing. Hey Siobhan. Is everything okay? I mean right now we have a… There’s a lady on the floor that’s not doing too well. And if you have a moment, that’s something I want to review with you. Yeah yeah, tell me about her. Well, over the course of the day she’s needed more and more oxygen. I’m worried that she’s heading in the direction of needing to go to the ICU. Okay. I was hoping that you could come with me and we can take a look at this patient. Actually yeah, why don’t we just go do that now? Do you want to do that? We can just see her and figure out… Walking into the patient’s room it’s clear she’s working hard to breathe, as if she’s just been sprinting but really she’s just been lying in bed. Despite all the medications we’re giving her, she’s actually getting worse and needs more help breathing. So the next step is to call ICU and move her to a more monitored environment, which is designed for sicker patients. Okay, so this is Sonya. She has actually matched to emergency medicine. So you are gonna be an emergency physician? I am! That’s awesome, congratulations. Thank you. And now we’ve got a consult for you here in the emergency department. A patient coming in with very very short of breath, requiring a whole lot of oxygen. So right now they’re already on five liters of oxygen, which is a lot. So take a look, see everything that’s going on and then we can chat about it after. Sounds good. Reasonable? Yeah. If you’re worried, come and get me. For sure. Okay, thanks. And it’s been three days since the bowel movement. For a suppository? In terms of her social history, she’s actually quite independent. She’s from a retirement home. She’s functioning quite well prior to coming in hospital, non drinker, nonsmoker. Hey, do you like my dog on the patient board? Mmm, is this 4 am brain? Oh, this?! What is happening? Is this like our 6 am anthem? We’re done with our consults, I think. Don’t jinx it! Did I just jinx it? Nooooo. Don’t say things like that, oh my goodness. Oh my gosh, I’m so sorry. You should know better by now. Hahahaha. I apologize. 6:30 a.m. Just got a page from the emergency department. This is truly the most dreaded time, because oh it’s the last-minute consult. I shouldn’t jump the gun, maybe it’s not a consult. We’ll find out. So it’s confirmed a last-minute consult. Patient had a fall and has a bleed in their brain. So you know what? I think I’m just gonna try and see it myself rather than getting one of the juniors to do it and hopefully just try to finish it off quickly. Finally done, this was a steady night. Honestly I’m so exhausted after doing this every other night for two weeks. Completely done at this point. But I had such a wonderful team and I want to thank them all for being a part of this video. So if you want to see more videos like this, don’t forget to subscribe and comment below if you have any questions, if you just want to say hi. Otherwise, I’ll be chatting with you guys next weeks. So bye for now!