Wednesday, October 27, 2010

The big three

I rarely get really obese pregnant mums for caesar.. of course pregnant mothers will always be overweight but to have a normally obese lady becoming pregnant is an upmost challenge! I've done quite a few previously but none matched the one I had the day before.. 150kg mother, primi.. just ate two hours ago and came for her usual antenatal follow up.. they can't detect her fetal heart rate.. the scan did not look good so : decision for LSCS..
when she arrived in OT.. hmmm... wow.. airway can be real bad if one opts for GA and the option is for regional.. i don't see any other way to ensure both mother and baby safety... "fat chance" hey? hahaha
you cant feel anything behind there.. totally fat up and below... so how ah? well..i took the longest needle i can find and the only way to do it was the "ada rasa karen tak?" method.. it was not easy nevertheless but alhamdulillah.. i got it.. and LSCS with baby was well.. :)
I was in cardiac OT again.. and we were doing a fairly simple "pericardial stripping" case. This unfortunate gentleman had gut TB few months back and had since went into cardiac failure symptoms. The cardiologists thought it would benefit him to have the fibrosed pericardium to be peeled off so that the heart can contract better and perhaps improve his failure symptoms. He was otherwise healthy before that bout of infection.
It was a simple sternotomy with the heart visualised directly. it looked dirty and very typical of infection like lesion around the heart. of course, with such fibrosis you can never predict the friability.. and yup, to make the story interesting the right atrium pun TER-BOCOR!! waaa... major resus done as the cardiac output was literally off the drain! it was impossible to close the defect immediately and the heart stopped beating almost immediately. The trainee cardiac surgeon had to commence the direct cardiac massage with the main surgeon busy trying very fast to establish a fem-fem bypass to the CPB machine.. And of course, the anaesthetists all working overtime as manual "Level-1": pumping as much blood and volume into the circulation to maintain it before one can define death phsilogically! We could lose the guy anytime.. he was at the verge of death due to no more blood in his circulation!
We managed to put him on bypass and that geve the surgeon the time to repair what was damaged.. but it was not an easy task.. They did not close the chest as the possibility for reopening the chest was there! The success for the episode was; we were able to get him of the bypass machine... and such release. Till date he is still in CICU and I'm not sure if he can make it..
Adrenaline rush on the go? only crazy people would yearn for a career like this... hahaha so am I in that category? haha

1 comment:

Gaban said...

Giler aah punya experience!!