<\/p>\n
So you spent the past few years taking photos of patients history files and copy pasted your friends work with minor tweaks? Well, when you start your career, you\u2019ll feel like an idiot, and will most probably perform like an idiot clerking patients and subsequently reviewing them. Clerking is really simple. It\u2019s simple enough even an idiot could do it {i.e. Me}, so all you smart kids shouldn\u2019t have any problems.<\/p>\n
<\/p>\n
Just follow 3 simple rules, concise, relevant, and accurate.<\/p>\n
Concise: Don\u2019t write an essay, get to the point.<\/p>\n
Relevant: If patient comes in for APO, don\u2019t order BFMP investigation.<\/p>\n
Accurate: If for example a patient comes in with fever, it is vital to know the exact date of onset.<\/p>\n
<\/p>\n
There are plenty of other nonsense but I\u2019m sure you get a rough idea.<\/p>\n
<\/p>\n
Before we begin, it\u2019s important to identify our patient.<\/p>\n
Since I\u2019ve been recently working in the dengue ward, I\u2019ll just use a Dengue Case as an example.<\/p>\n
28\/01\/2012 @ 6.00 PM<\/p>\n
30\/M\/F K\/C\/O HPT<\/p>\n
30 years old Malay Lady, Known Case of Hypertension<\/p>\n
<\/p>\n
Next to get the chief complaint;<\/p>\n
Fever x 4\/7<\/p>\n
Proceed to full clerking.<\/p>\n
+Fever x 4\/7<\/p>\n
– A\/W Chills and Rigor<\/p>\n
+ Vomiting x 2\/7<\/p>\n
– 3 Episodes Today (Induced by eating food)<\/p>\n
– Food Particles<\/p>\n
– 0 blood<\/p>\n
+ Diarrhoea x 2\/7<\/p>\n
– 4 Episodes Today<\/p>\n
-Brownish-Yellowish Stool<\/p>\n
– 0 Blood<\/p>\n
+ Arthralgia\/Myalgia<\/p>\n
+ Lethargy<\/p>\n
+ Bleeding Gums x 1\/7<\/p>\n
– Occurs after brushing teeth.<\/p>\n
0 Retro orbital pain<\/p>\n
0 Headache<\/p>\n
0 Abdominal Pain<\/p>\n
0 URTI Sx<\/p>\n
+ LOA \/ LOW<\/p>\n
+Tolerating Orally Minimally<\/p>\n
<\/p>\n
Last PCM Intake: Today at E\/D at 4.00 PM<\/p>\n
0 H\/o of IM Injections<\/p>\n
0 h\/o Jungle Trekking, Waterfall, or other such activities (TRO Leptospirosis)<\/p>\n
+Lives in Dengue Endemic Area, Recent fogging.<\/p>\n
+Menses started today, usual course 7 days, 2-3 pads a day, claims used 5 pads today.<\/p>\n
<\/p>\n
0 Surgical H\/o<\/p>\n
Insignificant family h\/o of hereditary disease.<\/p>\n
0 Non Smoker \/ Alcohol Abuse<\/p>\n
NKMA \/ NKFA<\/p>\n
<\/p>\n
O\/E Alert, Pink, Answers in Full Sentences, Full GCS, Fair Hydration<\/p>\n
0 Pallor, 0 Ankle Oedema, 0 Jaundice<\/p>\n
BP 130\/86<\/p>\n
PR 135 (Good Volume)<\/p>\n
T\u2019C 37.5<\/p>\n
Lungs Clear, A\/E Equal<\/p>\n
CVS DRNM<\/p>\n
CNS Grossly Intact<\/p>\n
CRT < 2 Seconds<\/p>\n
PA : Soft, Non-Tender. No Organomegaly<\/p>\n
Diagnosis: Compensated DSS In Febrile Phase Day 4 with warning signs (Persistent Vomiting, Lethargy, Bleeding Tendencies)<\/p>\n
<\/p>\n
IX<\/p>\n
FBC\/COAG<\/p>\n
RP\/LFT\/CE<\/p>\n
Dengue IGM<\/p>\n
VBG<\/p>\n
Serum Lactate<\/p>\n
GSH<\/p>\n
ECG<\/p>\n
DXT : 7.0 mmol\/l<\/p>\n
<\/p>\n
Plan<\/p>\n
1) Notify Dengue<\/p>\n
2) Ideal Body Weight (45.5 + 0.91(152.4-ht)). If difference between IBW and Real Weight is huge, just add IBW + Real Weight, divide 2, and take that value.<\/p>\n
3) Run 10 CC\/kg\/hr NS for 1 hour, and review. (Compensated DSS)<\/p>\n
4) T. Provera 10MG Stat then BD<\/p>\n
5) IV. Maxolon 10mg stat then TDS<\/p>\n
6) Encourage Orally<\/p>\n
7) Tranexamic gargle TDS\/PRN<\/p>\n
8) ORS Per Purge<\/p>\n
9) Pad Chart<\/p>\n
10) Hourly Vital Sign Monitoring<\/p>\n
11) Put in Acute Cubicle<\/p>\n
12) Inform MO<\/p>\n
13) Trace IX and Review<\/p>\n
14) Withold Antihypertensives<\/p>\n
15) IV Omeprazole 40mg BD<\/p>\n
16) I\/O Charting<\/p>\n
<\/p>\n
That\u2019s roughly the gist of how you clerk a patient. Probably not the best clerking ever, but it\u2019s good enough to survive. So now we\u2019ve got this patient on a bolus, it\u2019s time to do a post bolus review.<\/p>\n
<\/p>\n
28\/1\/12 @ 7.20 p.m.<\/p>\n
<Post Bolus R\/V><\/p>\n
30\/M\/F K\/C\/O HPT<\/p>\n
Compensated DSS D4 in Febrile Phase with Warning Signs (Persistent Vomiting \u2013 Resolved) (Lethargy) (Bleeding Gums \u2013 Resolving)<\/p>\n
C\/ Completed 10cc\/kg\/hr NS x 1 hr<\/p>\n
+ No more vomiting \/ No Nausea<\/p>\n
0 Abd Pain<\/p>\n
+Resolving Gum Bleed<\/p>\n
0 Other Active Complaints<\/p>\n
<\/p>\n
Blood IX <\/p>\n
HB 13.0 WC 1.42 PLT 87 HCT 43 LACTATE 1.9 PH 7.33 HC03 22 CK 300<\/p>\n
Noted Carditis<\/p>\n
O\/E Alert, Pink, Answers in Full Sentences, Full GCS, Fair Hydration<\/p>\n
BP 120\/80<\/p>\n
PR 115 (Good Volume)<\/p>\n
T*C 38.8<\/p>\n
Lungs: Clear A\/E Equal<\/p>\n
CVS : DRNM<\/p>\n
PA : Soft\/Non Tender. 0 Organomegaly<\/p>\n
CNS : Grossly Intact<\/p>\n
CRT < 2 Seconds<\/p>\n
<\/p>\n
P\/ 1. Cut down IVD to 7cc\/kg\/hr, and review in 1 hour<\/p>\n
2. Blood IX, FBC, LACTATE, VBG<\/p>\n
3. Trace IX<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
This would be a simple review. A patient that was running a 10cc bolus due to Compensated DSS, is now tapered down to a 7cc bolus as she is responding. You trace the 10cc bolus bloods and review the patient again in an hour and check all her parameters, if you like what you see, taper down your bolus again, if you don\u2019t, restart a bolus.<\/p>\n
As always, be careful when running bolus. Don\u2019t wanna overload the patient, always auscultate the lungs for the dreaded bibasal crepts!<\/p>\n
<\/p>\n
That\u2019s all for now, I\u2019m too tired. Bye kids! Hopefully this update isn\u2019t incorrect, I\u2019m as sleepy as hell while typing this.<\/p>\n","protected":false},"excerpt":{"rendered":"
So you spent the past few years taking photos of patients history files and copy pasted your friends work with minor tweaks? Well, when you start your career, you\u2019ll feel like an idiot, and will most probably perform like an idiot clerking patients and subsequently reviewing them. Clerking is really simple. It\u2019s simple enough […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/hypog.net\/blog\/index.php?rest_route=\/wp\/v2\/posts\/858"}],"collection":[{"href":"https:\/\/hypog.net\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hypog.net\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hypog.net\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hypog.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=858"}],"version-history":[{"count":1,"href":"https:\/\/hypog.net\/blog\/index.php?rest_route=\/wp\/v2\/posts\/858\/revisions"}],"predecessor-version":[{"id":859,"href":"https:\/\/hypog.net\/blog\/index.php?rest_route=\/wp\/v2\/posts\/858\/revisions\/859"}],"wp:attachment":[{"href":"https:\/\/hypog.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=858"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hypog.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=858"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hypog.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=858"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}