Palmo Anest

1st Call of the month.

I was oncall on the 3rd of Sept. This is the 1st time in 2-3 months that I actually see empty beds (2 of it!) in our 7 beds ICU. However after my colleague passing to me, I know it was not as relieving as it seems to be.

We have 3 very very ill patients in the ICU which is enough to torture me till next morning. One of the patient, Mr. T an old man who had just transfered into our ICU erly in the wee hour from a near by hospital. He has been in their ortho ward for 1 month, treated for cellulitis and necrotising fasciatis. However like many other old man with prolonged stay in general wards, he developed Broncho Pneumonia and the lungs getting worst. What irritates me most is the referring ortho MO dare to told us that they had been managing this case without medical involement since in their hospital, ortho and medical not getting along well! WTF?? Because of that si-tiu-pid reason the poor ahpek developed respirator distress and their anaest intubated the ahpek however their ICU was full, thus sent him to us!

On arrival, the ahpek is in severe sepsis, ARDS, needed double inotropes and high ventilator setting! What a bunch of irresponsible orthopods! (well, I used to like the job, glorified carpenters, just bang and screw everyday... chuck all the medical problem to physician and anaest!)

The 2nd ill patient is a maternal case. Post Caesarean day 30, came in with sever sepsis ?source and Acute renal Failure. Showed CNS symptoms with sudden dropsand fluctuate of GCS. Family refused CSF tapping (as usual with most malay family). CT sacn showed an hypodense area at left parietal area reported as ?infarc/abcess, sent the film to Neuro Surgeon for opinion and was reported as infarc again. We intubatedand ventilated her to protect her airway and she has been with us in ICU for 10 days. May problem had been her renal failure. However 2 days ago she started to develop fits.. and getting increasing in frequency and duration, yesterday, on top of her phenytoin, and midazolam infution, we had to add Sodium Thiopentone infusion to arrest the seizure. She still having breakthru fits with all of these. I'd think its intra cranial pathology coz she was not hypoxic, metabolyte and electrolytes are within normal range... God help us...

Hmm.. been whining too much. I wouldn't want to talk about the 3rd patent now. Am just letting go of my frustration.. you guys don't have to read these..

I felt better now! Cheers! :)

posted by LT @ 10:21 PM