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An Afternoon at the Radiology Dept

Posted Jan 07 2009 6:04pm
As i have mentioned earlier, I am currently based at Queen Margaret Hospital. One afternoon, I've decided to follow 2 of the patients that I clerked in to their ERCP. (ERCP = Endoscopic Retrograde CholangioPancreatography, is a procedure done to investigate whether there are any stones in one of the ducts in our body). I have never seen one done before and was pretty much excited about it.

So, at 2pm, I made my way to the radiology dept. Asked the permission of both patients and also the consultant who was going to carry out the ERCP. Having given the green light, I waited for the procedure to start. And then, the horror started.

The consultant started bombarding me with questions regarding ERCP. Obviously, I didnt prepare myself for this, because, I've never been asked about anything whenever I follow a patient to all these procedures. I totally know nuts about it. So here is the short session I had with the consultant....which I found, sort of intimidating.

Consultant:Right, we're going to do an ERCP, I'm going to sedate the patient with pethidine and midazolam...what are the problems that can arise from this?
Me:The patient can be over sedated...hence leading to breathing problems.
Consultant: ok...what breathing problems are u talking about?
Me:ermm...(i dunno why i couldnt come out with the words "respiratory depression" at that time)..errmm...the patient's saturation will drop.
Consultant: ok....so the patient's respiration will be depressed...so ok, what if, the patient's sats drop to 94%, what will you do?
Me:hmm...give the patient oxygen?
Consultant: Correct. What if the sats keeps on going down despite the oxygen? What are you going to do?
Me:hmm...give oxygen...and..ermm...continue to monitor...do not give any more midazolam.
Consultant: ok...but is that ALL you're going to do?? the patient's sats is still going down and is about 80% now...

--at this point, most of the nurses in the room were listening to our conversation and were looking at us---


Me:
ookkk, ermm...oh...i guess u can reverse it.
Consultant: what's wrong with you?? why are you being so diffident?
Me:(i didnt understand the word, "diffident", but nemind..i didnt respond to his comment, and my face was red and burning)
Consultant: ok..so how are you going to reverse it?
Me:hmm...mmm...oh..naloxone??
Consultant: NALOXONE? are you sure?? what is naloxone used for?

--Forgive me, i sort of lost of confidence at that time...and just couldnt think straight, so hence, blurted out anything that came immediately in my mind. i knew that i've dug my own grave---


Me:
oh no...its for opiods...mm...ermm...yeah, flumazenil!
Consultant: Right, finally....ok...so wat are the complications of this procedure?
Me:hmm...I suppose patients are at risk of bleeding, infections...
Consultant: u know, bleeding, infections...these are so vague. You're not answering my questions like a final year med student. So, now, can u please start again. (spoken in an unfriendly manner)
Me:(I was abit taken aback...gulped down a lump of saliva) You can get infection from the bile duct...which is called...cholan...cholangio...cholangitis...
Consultant: Fine, to be more accurate, ascending cholangitis. What else?
Me:errmm...bleeding...from the pancreas??
Consultant: pancreas??? do u even know how an ERCP is done?? We do not even enter the pancreas...
Me:(I blushed...everyone in the room was looking at me) Sorry, I was a little confused. I'm not sure where is the source of bleeding.
Consultant: ok, bleeding is from the site of sphincterotomy. and what other complications can you think of?
Me:errmm...errmm...errmm.. (was really trying to squeeze all my brain juice)
Consultant: There is something called ERCP-induced pancreatitis, which is the most important complication...
Me:ok..

---silence...then he started the procedure---

so there you are...my short session at the radiology dept...I totally lost myself. I admit that i didnt know much about ERCP, but I do know the answers to the first few questions. It was just that I wasnt used to being questioned in this manner... and became nervous....sigh...Life is tough....
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