Today is my first day of the training of community medicine.
Basically, we work with two attendings.
What is remarkable about this hospital are the age of patient(most of them are more than 80 years old) and the kindness of paramedical.
I have two patients today.
The first patient is 84 years old female, who had a right femoral neck fracture.
She said she was blew away in the strong wind when she was wanting for the bus.
The wind of Okinawa might blow not a leaf but a person away.
She had a pain but it was tolerable, but it was gradually getting worse. She went to the hospital near her house. She was diagnosed as right femoral neck fracture.
She got a Bipolar Hip Arthroplasty(Direct anterior approach) at the other hospital.
She come to this hospital for rehabilitation.
Her D-dimer was 12.1. We ordered the leg vein echo to check DVT( the echo found out that she has thrombosis at flounder vein.). She started to take Edoxaban.
The next patient is 86 years old female, who had cerebral infarction.
She lived with her family. Her daughter realized her mom ‘s way to talk is different from as always. She was taken to the ER and diagnosed as cerebral infarction.
According to the letter of reference, it says she had watershed infarction caused by dehydration.
That letter also said it was multiple infarction. It was considered as A to A infarction.
Dehydration was corrected, and Anti-platelet therapy was started. After taking antiplatelet (Aspirin)drug, she had melena and nosebleed, so it was stopped. However, she also has past history of angina, so taking Plavix or Pletal instead of Aspirin may be considered.
→Some days later, the doctor who treated previously sent the image of MRI. That MRI says she has not watershed infarction but infarction at both cerebral cortex. These are the multiple infarction. There are at both side not one side, which means it could be caused by Paf. There are no sign of Af at EKG. We ordered echocardiogram to check her cardiac function.
She also has difficulty in hearing, which doesn’t have relationship with cerebral infarction. She said deafness was proceeding after she was exposed to the sound of raid. That is thought to be noise-induced hearing loss. The loss of hearing is proceeding recently perhaps because of elderly deafness.
She came to this hospital for rehabilitation, too.