I was suppose to zap up the psy fellas on friday morning . Haks.. but things were definitely going tangently from the planned schedule. I arrived quite early about 7.15 am ; met the on call fellas from d previous nite.
" Good luck eks today.. Ada leaking triple A ( Abdominal Aortic Aneurysm )about 10 cm for you. 76 year old malay lady ! "
Mak ai..i said... Azrin , my new specialist , the new cool guy on the block was a bit panic when he heard the news !Its true what they said about new specialist being on call for the first time ; a very jonah period ! My partner for the day Tan , did the ECT instead and had to cover lots of other OT which went into distress as well.
It had been quite some time when he last did AAA.It was a bit haphazard initially as we had MRI list to do as well that morning ! Doing triple A is a bit complicated because massive bleeding may occur during the procedure. We were lucky though coz it was only leaking and not burst which would have been catatastrophic ! However once it is leaking you never know your luck though !
As we were doing the case ; multiple phone calls came in to inform cases ! Haks..and my list from only 1 , beranak to 4 pages ! And most of it big cases ! Damn it.. I had in the end 20 cases booked to do dor the whole night !And nobody was around to cover us ; so both of us missed Sembahyang Jumaat la pulak !!!
AAA went ok ;it went on for 4.5 hours and we did it ! Azrin was relieved when it was over. He was having a headache then as well as other OTs around the hospital were ringing for help ! haks.. but more was to come. Did a tracheostomy case from GICU. A 54 year old Indian lady ;3 days post thyyroidectomy . Thought that it was going to be a breeze but because of her previous OP , the ENT MO was unable to locate the trachea properly ! HAks.. the procedure which was suppose to be a mere half and hour went to 2 hours! The consultant had to be called in to do the trache ! And i can tell you , the unexpected length of time spoiled the day !
An 18 year old boy with volvolus came in immediately after being pested by Mr Kwan ( the UPM Surgery Specialist on call ) for a sigmoidoscopy KIV Laparotomy . Luckily he managed to untwine the volvolus through the scope otherwise unnecessary OP.
Immediately after that we had a relaparotomy for a 42 year old Malay guy , who was operated 3 x before this. His initial problem was gangrenous bowel and an anastomosis was made. However he went into sepsis and the leak from the fused bowel was repaired twice. However he did not recover and went septic again. He looked really ill and i reckon it was a good decision to proceed with his case. A funny thing happened during induction as i did not check his trache properly. There was no cuff and i had problems ventilating him initially. I did not realize that until i put hium on the ventilator ! Haks ! bodoh gile tengok air bocor ! However Azrin came to the rescue and changed the trache. The Op went OK.. and next we had another laparotomy !!!
our lovely on call room ; empty last nite ...
It was nearing 11pm when this 13 year old boy was brought in. A psy case as this boy jumped from the 5th floor to the ground and hurt his abdomen ! He had splenic injury and a splenectomy was done. Haks.. macam2 la pulak..
Suddenly ICU called and we had to intubate a 95%^ burn case from Batu Pahat.. gile nyer jonah dear !! Azrin was shaking his head. None of us really had any rest throughout the day ! Dr Thohirah ( our consultant for the day ) was still around till then .. managing the PACU case from UPM elective list. Unfortunately the patient had to be defibrilated as she went into SVTin PACU !!!! hahaha.. i was already laughing at this stage thinking what next huh..
As we were about to call a 76 year old chinese lady for another relaparotomy at 3 am , Mr Kwan pushed a case from Nephro ; a 65 year old Malay lady k/c of End stage renal failure with hypertension and Diabetes with a vague history of IHD ; currently in hypovolaemic shock ; intra abdominal bleeding caused by iatrogenic Stab Peritoneal Dialysis that late afternoon.It was pushed in and induced , intubated early ; we barely had time to set up proper lines for her. Imagine doing her case stat without CVP , arterial line and she had only 2 working 18G lines !!!
SHe had almost 3 L of blood who went gushing out when the abdomen was incised. We were pumping in blood like mad and at the same time controlling her BP. She was initially on inotropic support as her baseline BP was damn low. Azrin was so tired that he failed to insert the CVP line x 5 ! haks.. i was bust running around and pumping blood into her..
Amazingly , she was very stable intra op. Alhamdulillah i would say.. And we booked uro ICU bed for her post op ; but post extubation she was really stable with a full GCS ! Considering her urea level we thought that she might be difficult to arouse ! By the time we pushed her to the recovery , it was already 6.40 am ! haks..
I was really.. really tired when everything was done. My god !! Did not expect it to be this bad. We had to postpone 2 major laparotomies , one BKA for the guys on call the next day. On top of that , 2 laparoscopic lap for ectopics , 2 appendicectomies , 1 semi-e strangulated hernia , 2 ERPOC and a trache to do.
It was a good experience though , another day in the daily routine of an anaesthetist on call ..
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