Saturday, October 06, 2007

Amazing terror

This post is dedicated to the National transplant team who had worked hard in the past 72 hours

If lailatul qadar crawled through us last night , we wouldn't have realized it.

It was a hectic call for the team eventhough personally for my specific job it was one of the few referrals received. I had to join the OT team ( more of kay-poh-chi ) during near iftar as we had a ruptured triple A (Abdominal Aortic Aneurysm ) on table with my lecturer ( aka specialist ) and Chief MO having to attend a patient who had an MI in PASCA. I haven't done a proper AAA for quiote some time and it was indeed a challenge to induce and then manage them intraoperatively. Level 1 was all set and we did use it when the surgeon opened the abdomen. Blood was splurting everywhere when the tamponade was released and that was when we activated Level 1 ; one super-cool toy !!

I was having a short break for iftar in between ; when the Surgical MO barged into our room and urgently posted a laparotomy. It was young fella who just had his nephrectomy 2 days back and currently having a massive intra-abdominal bleed which is hay wiring his cardiovascular status. It did not make it better as he has a history of occasional SVT with an ejection fraction of 40% eventhough his ASD was corrected more than 10 years ago. True enough , during the operation patient arrested and we had to CPR him in the lateral broken-up position ( they went through his nephrectomy scar ) before putting him supine ! His ECG was mightily hay-wire after the adrenaline with a rate of 250 / min ! Prof was called in to help manage the patient and that helped to settle our adrenaline !

Earlier during the day , I was called to the Radiology Angio room as the patient who was pre cerebral aneurysm coiling collapsed during their trial run of vessel occlusion. Ling and Jahan ran there as well and we managed to intubate the patient .It was not the most ideal place to secure her airway but it went on smoothly. The nuerosurgeons and Radiologists were arguing what may have cost the fit and arrest - subjecting her to multiple scans for a proper diagnosis. When things like this happen you wonder whether we should meddle around with the aneurysm when she was well and assymptomatic ? Not for me to say...

ICU was no different with Azman having a torrid night managin 11 ill patients ; he too missed his iftar and you could see his inner self with the constant frowning when i looked at him from far.
Wow.. i missed sahur somehow but its "good" to have calls like this...

2 comments:

Shah said...

Was a busy nite for me too. Am doing my CT anaesthesia posting now & was priviledged to help out with the lung transplant case in OT that night. Glad that both the recipients are doing well now.

Dr.M said...

Yeah , read your entry ! It was touching and at the same time a very enlightening experience !