A close call

I had a bad call on Wednesday. It had been quite sometime since i felt so tired during the call and obviously collapsed the whole day yesterday. This was a typical HKL type call which drains everything out of you.

The day started off with an eye emergency ; to decompress the pressure built up in the eye due to a bad swelling after an accident. It was uneventful but i had trouble with the ecg tracing. I had to test it on myself before concluding that patient's skin maybe thick and intefering with the detection !! It took the ENT guys 3 hours before we're done.

After an uneventful insertion of ICP monitoring device , we were pushing an 87 year old who's just had a major surgery the day before ; coming with a hypovolaemic shock. At the same time , there was another old fella in his 80/s with a bleeding Gastric Ulcer on the other OT !! The two theatres were running at the same time and Prof had to visit both of the OTs concurrently !!

Most likely , it was due to a failed anostomosis causing massive bleeding and DIVC in patient. She was so "white" when she came and kept on vomiting blood. We quickly induced her ; I was doing the Sellick's manouver - and for the first time in my life I really pressed hard. I could feel the reverse peristalsis and fluid forcing through my fingers !! Now i know why cricoid pressure is DAMN important !!

Her ECG was showing MAJOR ECG depression - and the surgeons started straight away. Out came 2.5L worth of clot from her distended abdomen and she was badly bleeding. My consultant and Specialist were there too and we were literally squeezing all the blood that we have into her. It was a very stressful situation but luckily everybody stayed cool and we managed to recover her haemodynamics . She was then placed in PASCA with a total blood loss of 5 L.Thats why elective surgery can be so dangerous.

After that , we proceeded with few another laparotomy for perforated Gastric Ulcer which was uneventful and at about 11 pm ; the ENT team rang up and posted a retropharyngeal abscess with airway obstruction.They were not able to view his vocal cords via indirect laryngoscopy. Waahh !! this is bad . I've seen few before but this was the worse i've seen ! Patient was literally gasping with a loud stridor ; ( like a donkey ) . This was a thin 25 year old Indon , he looked really bad. He has been having the symptoms for 4 days and treated in Muar. It was becoming bad and he was referred to UMMC. His neck was stiff and he can't open his mouth due to pain. He can barely speak and looking very-very uncomfortable.All his fingers wer clubbed and we wonder if it is something chronic ? We didn't have any ICU bed left...

We were sorting a bed for him when we noticed that he was sweating badly. Quickly Prof pushed the patient into the OT and another drama began. We tried for awake intubation but it failed as the structures were not visible !! He then began to desaturate and we had to resort to inhalational induction. He was desaturating badly that his ECG showed alternate VT and bradycardic that we had to commence CPR ! Adrenaline and atropine was given , and he recovered. Prof at the mean tie managed to tube her via Bougie but it was really blind as she could not recognize any structure. It was very scary with 5 anaesthetists there reviving the patient !!

1 Liter of pus was drained from the abscess and due to not having any ventilators present , the ENT team did a tracheostomy for him. He did not look well and i guess sepsis was on board. We managed to wake him up and he was breathing comfortably on his trachy. I guess , it was much-much better compared to what he had before..

We were done by 3am ; and only then i could throw myself to the bed and slept like a log....