Severe Extended Gangrenous bowel
My colleague had a case of 32 years old man came in with acute abdomen and sever sepsis the other day. Case booked as PGU (claimed stable and failed to mention sepsis while booking) by surgical team.
Upon opening up... that's what we got. Most of the bowels are all gangrenous and lots of adhesions. This chap had an appendisectomy done 2 years ago and since then had been seeking A&E and GP's treatment for abdoment pain every now and then.
His wound was left open with abdominal packs and an urobag suture on top of the laparotomy wound then sealed with Tagaderm. (The picture shows the content after we removed the urobag and packs, can still see the sutures around the wound)
We brought him back to OT the next day hoping to resect the gangrenous bowel and closed back the wound. We gave him ASA classification of 5E for the 2nd operation. We had to CPR him on the table and later twice again in the ICU. When I left the hospital it's about 5:30pm and he is still there but we know we are loosing him already. This morning when I went to work his bed was occupied with a new face.
Triple Lumen Central Vein Catheter insertion under Image Intensifier.
A morbidly obese 50-ish lady weighing 140kg with necrotising fasciatis of the left leg. The initial wound debridement was done but we think that she'll need another debridement on the day I was last on call. He Hb (haemoglobin) was also on the low side at 8.3g%. We inserted a triple lumen thru her right subclavian vein in preparation of better monitoring of her fluid status. Subclavian route becouse she almost have no neck for Int. Jug. cathetherization.
This is the the check x-ray we got. The Triple lumen went up to the Rt. Int. Jugular. Very poor film.
I re-inserted the triple lumen at right subclavian again and we had this check x-ray. Again it went up to the internal jugular. We think 2 is enough and she is also started to grumble a lot by then. We decided to re-insert the triple lumen in the OT before the ortho team started the wound debridement and we can confirm the placement with Image Intensifier.
Under the image guidence, we clearly sawe our guide wire went up easily to the int. jug. if we change the direction making it turn down, it'll kink and made a half u-turn, or it went to the left side of the body. From that we think that there's a obstruction on the right side. We went on to set a triple lumen on the right subclavian and it went into the superior vena cava smoothly.
There must be some sort of an obstruction on the right side. With the some what widen mediasternum there.
High Tech Gunman
The policeman who had been
shot during an anti-vice operation were in my OT early in the morning. Anybody noted the pictures in the newspaper that they actually are using few PDA phones? Now, if they are just using something like O2mini, I wouldn't tag them as high tech, but one of the PDA phones are actually a Treo650! That would be a techie guy to me. Wonder what's in his Treo and how it help him in his 'business'. :)
The policeman were sent to Penang in the morning for vascular team to follow-up. Hopefully he is well.
Increase risk of MI and cancer following prolonged deep anaesthesia
Read from
book of joe about this interesting
article from Los Angelos Times regarding the increase risk of cardiac and cancer death following prolonged deep anaesthesia.
This is part of what Shari Roan, Times Staff Writer wrote:
Now, two startling studies suggest that the effects of anesthesia linger for a year or longer, increasing the risk of death long after the surgery is over and the obvious wounds have healed.
"We don't know whether the things we do really have an effect that lasts out to a very long period of time, but there is enough evidence to suggest it might," says Dr. David Gaba, a professor of anesthesiology at Stanford University School of Medicine. "Even if it's a subtle and fairly uncommon phenomenon, it could affect an awful lot of people."
About 20 million Americans undergo surgery with general anesthesia each year.
Worries about the long-term effect of anesthesia — and the demands for additional studies — began to emerge recently when two research groups published papers linking deep sedation and an increased risk of death in the year or two after surgery.
One study, presented last fall at the American Society of Anesthesiologists annual meeting by Swedish researchers, showed that the duration spent under deep anesthesia is a significant risk factor for predicting death up to two years after surgery. Although the patients in the study were undergoing non-cardiac surgery, most deaths resulted from heart attacks or cancer.
The other study, published in the journal Anesthesia & Analgesia in January by Duke University researchers, found that longer amounts of time spent under deep sedation increased the risk of death in the year following surgery. The patients in the Duke study underwent major, non-cardiac surgery with general anesthesia, and again, deaths in the first year after surgery were primarily from heart attacks or cancer.
Now I think we would have to use our
BIS monitor more often (we don't use it for all the cases coz of the cost of the probes - rm100+ / piece). I personally find the BIS monitor very useful in controlling the depth of anaesthesia.
The Chosen One
Got to be the chosen one again. This time I surely don't like it. It's the
Khusus Kenegaraan. I remembered when I attended my
Khusus Induksi organised by
Jabatan Kesihatan Negeri Pulau Pinang, the organiser told us that we don't have to attend this particular Khusus tatanegara any more coz they have included the module into our
khusus induksi.
To me this is a khusus that wasted time and money. However, this is one of the khusus that the admin will gladly let us claim for the transportation and what not(probably coz all govt emplyees have to go, including admin ppl). However govt money IS our money! Come on, we have had tatanegara in primary school, then secondary school, later in form 6... I dunno about local uni coz I wasn't the lucky chosen one then. The same thing were repeated in the induksi and now we need to attend the khusus again! What a waste of time, money and energy!
This khusus will be held on 7th to 11th July but we only get the letter on the 4th of July! They thought we are in the army or what? Always
sedia berkhidmat, saip sedia menerima arahan eh? By allowing 2 of us to go, my departments have to make lots of changes of the duty roster etc...
I'm sure it's going to cost the govt thousands of ringgit per head for this khusus again. I'll said give all the budget of this khusus kenegaraan nation wide to the BPR (Badan Pencegah Rasuah) to empower them and we'll sure have better civil service!
![[Valid Atom]](valid-atom.png "Validate my Atom feed"){kind=small}