My status is a bit funny though ; as i was born in Selangor , stayed in KL but yet i am a registered trainer from Negeri Sembilan! I will not however change my allegiance as i am comfortable on where i am. Most of the fascilitators are above 40's club ; i am somehow a bit "sesat" being in this group of people !! But the experience you gain from them is worthwhile !! Besides the N9 lot are a fun lot .I CANNOT stop laughing or grinning when we are together in our accomodation during "kursus"..saucy jokes and stories!!!!!
Something interesting happened in P2 ( my ward ) yesterday. Did not blog it down because i was too tired last night - pushed myself in the evening to complete the Kiara Hill track jogging non-stop !! Man ..i was so konked out last nite !!!
It was at about 11am - it was a passive day and we were all sorting out the patient's management decided during the rounds. There were lots of ill patients admitted during the active day. Suddenly one of the nurses shouted - patient bed no2 stopped breathing !! So it was the normal routine bringing the resus trolley to the 65 year old Indonesian man -treated as Sepsis 2 to Pnuemonia . then at the same time , another nurse shouted - another patient collapsed. And the other group went to attend the 70 year old Chinese men with stroke. The patients were literally side by side and both were bad - the anaes team was called in for ventilation.
Then suddenly a loud outcry from another corner of the ward by family members.. a 71 year old Malay man with upper GI bleed 2 to over warfarinized INR of 10 !!! ( normal.. 1 - 2 ) damn.. another team went there ; the housemans were actually the ones leading the resus.. in P2 there were only 2 trolleys , only 2 sets of resus equipment !!! All staff were busy doing CPR. and we had to make the decision.. which one to let go.. Damn... damn.... damn.... which means that we will only do CPR on the patient.. WITHOUT ANY MONITORING... WITHOUT ANY BAGGING... NO INTUBATION... The scenery was chaotic..
Of all 3 , the prognosis was worst for the 71 year old bleeding man. therefore , he was the one being resuscitated without full complete monitoring - initially he had no pulse n not breathing spontaneously.. adrenaline was pushed in n he responded.. his BP was readable and pulse palpable !! Imagine.. having to resus the old fashion way without ECG , digital BP reading.. and manual mouth to mouth respiration !!! damn.. damn...
PAtient no2.. had VF.. his ECG pattern went haywire.. we ran to him stat and defibrillated him 3x ...( always my favourite part of resuscitation.. macam gemapque jer buat.. CLEAR !!! ) his BP n pulse did not respond.. then his ECG went asystole.. even after adrenaline n atropine x6. He was pronounced dead after 20 minutes of resus. IMMEDIATELY.. we pulled of everything off him and brought it to man no 3 !! Anaes who arrived was pissed off with the inadequate fascilities..
The indon man.. initially responded to CPR.. failed us. He was scheduled to be transfered to ICU after intubation. he went asystole again n did not respond to the second resus. He was pronounced dead 1 hour from the initial resuscitation.
And guess who actually held on.. Yup.. our 71 year old Pak CIk , eventhough with massive bleeding ( fresh malaena ) hanged on and was only intubated after the Indon patient died. His pulse and BP was there with full blast inotropes , blood transfusion going on and he was still moving ( we had to give lots of sedation ) All efforts now was concentrated on him.. He was bagged for more than 3 hours as the anaes team mobilized the ventilator in the main building !! He was transferred to ICU later that day..I dont know whether he survived as i was on leave today..
It was so chaotic.. so havoc.. never had this before. It was harsh reality when things go wrong.having to decide who lives and who will not. Limitations in the government hospital will always be there... but i salute everybody , the attendants , the nurses , house officers and my fellow colleague for the tireless effort to give the best care for the patient. It was kelam kabut but everybody was doing their best to salvage the patient. Never ever doubt.. or even dare to question our commitment and effort for the patients!@! I can assure you that we do our best ; our very BEST....
p/s maybe too many medical jargons this time... sorry bout that .dunno how else to explain. kang explain panjang sangat la pulak blog.. !!
No comments:
Post a Comment