Wednesday, July 15, 2009

Back in business

I was on call on Monday after a long lay off. I was excited in a way because after one month of medicine and 2 weeks of "doing the Trunkey" ;I was up to exhilarating work! Hahahaha.. nuts or what? wishing myself to be a jonah!
Well.. as usual with the calls that I have nowadays; I am not Jonah anymore. I guess only in combination with certain colleagues would dwell me into such hyperactivity! Hahahaha
It was the usual stuffs going on and not as hectic as i know the potential it could be.Doing BAD ICU cases is not as exciting as how it used to be.. hahaha.. macam dah tua je rasanya !
At about 8pm , I was informed of a case ; 50odd year old gentleman DM,HPT,CHF,IHD who had an MI 3 months back and complicated by persistent VT requiring ICD insertion. He came for having an infected diabetic foot. It was told to me that the patient needed only "a bit" of wound debridement. On a normal circumstances , it would be absolutely nuts to attempt such high risk case at night. Therefore, i thought a simple ankle block would do it. So i called the patient nearing midnight.
It turned out that the foot was smelly and a likely candidate for BKA. However , the patient was not keen for such an immediate debilitating surgery and opted just for debridement. When i opened up the wound , it was impossible to give a simple ankle blcok and aarggh.. i am stuck to do this patient and there was no turning back.. hahahaha

lateral approach
I was fanciful enough in attempting lateral approach of the sciatic nerve block. He refused the posterior approach as he reckons that he'd become uncomfortable. I thought it should not be a problem.. but there was a keloid scar along the groove where i should poke my needle ; remnants of a 10 year old femur plating !! The attempts were futile as I kept hitting a hard surface ( which is liely to be the plate there !) Failing the stimulate the sciatic nerve , i tried on to visualize it via ultrasound. Again... i could see nothing as the anatomy is totally distorted ! Oohhh.. it was stressful because the only way was to perform peripheral regional block which would not jeopardize his already poor heart !!

In the end , i had to resort to the ever reliable Sciatic nerve block via Labatt's approach!! haahahaha.. Luckily the twitch was not hard to elicit and with a saphenous nerve block cover ; he was ready to be on OT table ! I was initially worried because the block did not work instataneously ; but astime went by. he was sleeping like a dog! Yesss... and of course, the debridement was very EXTENSIVE.. and i pray for his recovery..
P/S And on my post call day, the victims of the RAPIDKL bus crash was rushed to UMMC! Hmmmm... macam FInal Destination la pulak... hahaha

3 comments:

Dr Zek said...

Ko jonah cam dulu ker ? haha...aku dah mandi bunga, dah x jonah dh...anyway, aku dah lama x buat sciatic nerve block since i was transferred to district hospital. Kalu aku buat kes pun yang ASA 1 or 2 jer...

P/S: kene mandi bunga bawah jambatan untuk buang jonah...for Jonah DOC...huhu

faiz said...

Salam doc, i had so much fun reading ur blog ;] u are so happy-go-lucky that u didn't even looked like a stress doctor hehe

btw, i am very interested in anaesthesia...insyaAllah there are 2 more years to go b4 my graduation..and hopefully i can learn much from ur blog =]

Mafeitz Mamat said...

zek: ingat lagi ek? kah kah..skrg tak teruk sgt. masa mula2 dulu mmg teruk aaa...

faiz: Salam..:) thank u 4 reading my blog! Well, by taking everything easy the stress goes off. Anaesthesia can be daunting to some..but of course , you just have to make the stress to your advantage!!