Dear Sir,

       I’m Tan Li Mei, (roll number: 021303073) from the
current Medicine posting group D1. Please allow me to
explain to sir on the cases I’ve seen and a few
procedures that I’ve been given the opportunity to
have a hands-on experience during this afternoon’s
self-directed learning session.

       I was in the midst of history-taking in Ward 8 (Male
ward), Bed R4, when a patient in the next bed (Bed R3)
suddenly developed respiratory distress. The medical
officer present at that time then asked me if I’ve
taken any arterial blood sample for blood gas analysis
before. I then asked for his permission for me to
learn doing it as my first time.

       I then learnt to perform a femoral arterial puncture
and patient’s blood was sent for an arterial blood gas
analysis (ABG). Apart from that, I also learnt to do a
urinary bladder catheterization with Foley’s catheter
on the same patient. As soon as we completed the
bladder catheterization, patient suddenly became very
restless and tried to pull out the catheter. He also
removed his shirt and wanted to run away. The doctor
and I struggled to hold him onto the bed and a nurse
came immediately to tie both patient’s upper and lower
limbs to the bed. After awhile, patient calmed down a
little and I continued to clerk the case which I had
initially started with on the neighboring bed. The
details are as below:

Name: Mr...
Age: 52 years old
Address: Muar, Johor
Occupation: Lorry driver
Race: Malay
Date-of-admission: 13 / 06 / 2006

Chief Complaints:

·       Chest pain for 1 hour
-       associated with sweating

History of Presenting Illness:

       Patient was completely alright until 9.00am
yesterday, when he suddenly developed chest pain. The
pain was crushing in nature and lasted for around 1
hour.
Patient sat down for a rest but the pain still
persists. It was also associated with sweating. There
is no history of nausea or vomiting, no shortness of
breath, no orthopnoea and no paroxysmal nocturnal
dyspnoea. There is history of Hypertension for 5 years
under treatment. Patient was a chronic smoker
(20 sticks per day) but stopped smoking 10 years ago.
There is no history of Diabetes Mellitus.

               Due to lack of time, I only managed to take my
history until this point as it was already almost 4pm.
Very sorry about this, I will continue to clerk the
patient tomorrow as well as do the examinations
required. I will also clerk the previous patient whom
I had done the arterial puncture for blood gas
analysis and inform sir with further information that
I’ve obtained.

Thank you very much.

Tan Li Mei
14 /06/2006