THe Ruptured Ectopic..

OT 5 in HKL! 

I was on call on Sunday. God ! This month i've been overworked having 3 weekend calls ! Nasib baik claim kira ok la jugak , otherwise i would call this bullying !! Anyway , this month was a bit tight as the Masters students were taking their exams. Therefore only a handful was left including rookies like me. Well , so far i've managed my cases well so Alhamdulillah.

The call was ok , there were only 2 left overs from the day before so when i arrived at 8am i called my first case early with the vision of finishing all early ! haks.. tu la pasal , orang malas kan.. Anyway , The cases went smooth till about 2pm when we had to do 1 laparotomy for Intestinal Obstruction.

The patient was a 45 year old Indon Man ( however his IC said that he was 58 !! but he looked more 45 and he claimed to be 45.. so i'm not too sure who's IC he actually used.. ) Usually when u have emergencies with Indons , its never good. True they have a high pain treshold but the extent of their disease or problem is usually extensive. As it was in this case ; he was induced smoothly - intubation was easy , his lines were accessible and no problems initially. ntil the abdomen was opened.. my god.. His gut just popped out and it was very dusky and parts of it was bluish with sentiments of black coloured bowel. My..my.. that sounds trouble. He had gangrenous bowel ooh.. dah la busuk !! The Specialist surgeon quickly called upon her consultant .. And imagine his vitals went haywire after that! He went acidotic with pH of 7.03 and we had to resuscitate him as the surgeon continued their exploration and cutting the bowel out ! He was on double inotropes and the ECG did not look that good ! At this point , Our specialist came in to help.


posing depan machine 

And imagine , during the comotion , i had a phone call from the emergency department. The Gynae MO informed that there is this other Indon Lady , 27 years of age with ruptured Ectopic ! U/s abdomen showed free fluid and her pulse was really tachycardic .Her Hb was 5 g/ dL and they are actively resuscitating her!I told them to hold on for a while but the gynae team was pushing her stat to the OT. Haks.. at this point i was a bit panic and quickly informed my specialist. And we were to open the 2nd OT !!

When the lady came in , she was small sized lady weighing about 40 kg . She was still smiling but i knew that she was in pain. Her abdomen was distended and tender , very pale and her pulse was racingly fast !! I explained to her about the anaesthesia and quickly induced her. It was easy though , but we were putting lines all over her to resuscitate her volume. When they opened her abdomen , MY GOD !! Blood was gushing out macam pipe ! kabut siut transfusing blood into her !! MAcam main pump laks.. hahaha.. Luckily my GA nurse was the experienced one so she helped a lot without me having to give instructions. My specialist was in as well , in between runnig to the OT next door helping Mona managing the earlier case.


My toys! 

She lost about 2 liters of blood from the ruptured Ectopic ! They managed to stop the bleeding , did the salpingectomy and it was sorted. Meanwhile we topped up 2.5 liters of blood into her. Imagine losing 2L at her weight ! She was definitely a disaster waiting to fail on us ! Alhamdulillah it went ok.. and i was glad that we managed to settle the casein one hour . Though it was a nervy experience , it was good for me to have this type of problems during my call.. Experience man..experience.. so that i know what to do when i am in a similar episode in the future..

The laparotomy ended after 5 hours! haks.. kesian Mona she was so exhausted after the case . We sent him to ICU for care as the man lost about 1.5 meters of gut! Hmm.. tu la.. Indonesians.. somehow clogging our hospital with simply problematic cases.I've had lots of them during my tenureship not just here in anaes but during my previous postings. True its good for experience but the burden it puts on the government may delay service to our own countrymen.

Oklah.. tu jer nak cerita. panjang la pulak.. heehehehe.. Cant wait for our badminton session tomorrow nite !!!