Palmo Anest

Laparotomy day

Was on call yesterday. Very bad day indeed. Early in the morning at 8am soon after taking over from post call colleagues, we have the 1st emergency,

A young lady with 2 previous LSCS 36 weeks pregnancy. Coming in for bleeding placenta previa type 4 accreta.

She bleds ~4000ml of blood intra operatively. Was in DIVC, we ventilate her in ICU post op but able to correct her DIVC very soon with transfusion of blood and blood products. I extubate her in the afternoon and she is out from the ICU this morning.

Before this case could ended in the OT, we get a call from another hospital that they are sending in a road traffic accident case with open book pelvic fracture and intra abdominal injury. GCS 10/15 and BP very low at 50/30mmHg in the refering hospital. After the initial fluid resuscitation, patient's SBP picking up to arround 90mmHg,they packed and sent the case to us.

When I saw him in our A&E, whihc is actually 59 minutes after they sent the patient (pt), his GCS dropped to 7/15 and SBP hangging around 60-70mmHg. I intubated him and get 2 14G branulars on him then sent him up to OT.

This pt had a few parts of his intestine (both small and large) perforated and rupture mesentric artery. He also had lots of retro-peritonium bleed with the unstable pelvic fracture.

Surgical team repaired the ruptured & tears. Ortho team came in later to ext. fix & stabilised the pelvic fractures.

The pt bled 10L of blood. We massively transfused him with blood & blood products. On doable inotropes support on table & post op. We lost the pt @ about 17:30hr.

While the surgical team closing the abdoment, we get a call from anothe hospital that they will send in a case of stab wound. 6 inches deep ?Kidney injury, unable to control bleeds with packing in A&E.

Again we get all 'excited', prepare for another 'blood sucker'. Luckily on the table we found out that no major organ was injured & the surgical team did a good job to secure the bleeding. The pt was discharged well to general ward.

The 4th Laparotomy of the day was actually booked with me early in the morning when we are doing the 1st LSCS. However, we had to operate on the trauma cases 1st. Now, this is a 70 yr old gentleman with Ischemic Heart Disease and Atrial Fibrilation, on Warfarin and digoxin! Came in with sepsis secondary to Perforated bowel. He actually admitted the night before I on call but the surgical team was trying to correct the coagulation profile. In the morning when they book the case with me the INR is 2.7. Intra-operatively uneventful but he developed fast AF post op with BP chrushing. When I left this morning, he was on Dobutamine, NorAdrenaline, Digoxin.

Ad my 5th laparotomy, it's 6 or 7 pm by that time. Is a teenage young lady with an gynaecogical mass, stable, not rupture or twisted or anything emergency about it... But have a 'very demanding' parents. So the case was booked with me as emergency due to a 'very angry' father has been pestering the gynae consultant to op on the poor girl...

Being a 'very considerate' doctor.. (ahem, ahem.... ) we finally agree upon using our emergency resources (emergency OT) to operate on this not-so-emergency case of laparotomy. She is now recovering in gynae ward.

After that it was all other common day-to-day cases going on and on till 3 something in the morning...

What a day man! I had a bad day, but hope you all will have a great day!

posted by LT @ 6:15 PM