Palmo Anest

Stop disgrace us in the service... buckle up your act!

[sorry for the long rambling..]

When we the government doctors complaining about our over work, under paid working condition... There are certainly some of us in the fold really don't deserve any pay raise... They can continue to endure in their slackiness instead.

This is not new, it happens very frequently... hope the local A&E ppl notice and change... a big hope.. Have seen many A&E MOs comes and go, earlier year they don't have enough experience (claimed they had only 3 basic posting as houseman before being posted into A&E) now most of them there had completed 5th or even 6th posting what else if it's not the attitute?

Today at almost 6am in the morning, I was informed by my surgical colleague that there's a MVA (Motor Vehicle Accident) victim in the A&E (Accident & Emergency Department) that needs immediate surgery, a laparotomy for intra-abdominal injury. Was also told that this patinet is in severe shock, BP was very poor from unrecordable to very low of about 80 mmHg systolic BP.

I went down to A&E immediately to assist in resuscitation and prepare the pt (patient) for immediate operation.

Meanwhile in A&E, this is what make me most angry. This pt was brought into A&E at about 3am+, initial BP was SBP 80+ and after fuild resuscitation, when up to 140mmHg. A&E seems happy with this and nobody suspect any life threatening condition accept cerebral concussion and open fracture Tib/Fib (the leg bones). The case was to be admitted to surgical ward (for it's cerebral concussion) and refered to ortho for the fractures.

Luckily, my ortho colleague went on to see the patient in the A&E itself rather then later in the surgical ward. What he get in front of him is a very pale young man with BP unrecordable, and to add salt onto the wound, with just a 18G IV line running the IV drips (mind you this was a trauma pt brought in with BP 80+mmHG). Half an hour later the veins would have all collapsed, but luckily he (ortho) and the A&E team manage to insert another 2 branula and started colloid and blood transfusion and begin some sort of resuscitation (a sincere thank you for this ortho guy who are one of the few I respect and feel secure if he is on call).

They called in surgical guy (another friend), he did a DPL and it was possitive, this is when they called me.

I was actually just went to bed for less then half an hour before the call from A&E. Attended to the pt STAT anyway, to help in resuscitation, assess the pt and prepare him for the operation.

Being an anest guy, definitely start with ABC (Airway breathing circulation)...

The A&E team had already intubated the pt and was manually ventilated him with ambu bag and oxygen. However the ET tube is a bit too deep (we adjusted), air entry remarkedly less on the right side, surgical guy help to insert a chest tube (pneumothorax confirmed with gush of air and bubling drainage tube). SO airway and breathing was taken care of.

Circulation was really bad, there was only central pulse palpable, HR 150+ /min. Peripheral pulse not palpable and sPO2 monitor wasn't picking up any wave or reading too. Definitely severe hypovolumic shock. (who was those gave me the funny look when I ask for more IV lines to the pt? really think that the 3 18G is enough for this patient huh??) I ask for more blood to be crossed match and but nobody move... asked again.. atleast 3 times, even the senior MA there on that shift just murmur some thing but no one move again! I have to leave the patient, pick up the phone called the blood bank (luckily got a responsible man one the other side) he'll get more blood ready, pronto. (Blood bank MLT on night, I thank you for a good job done without delay).

At this time OT is ready, I've also informed my consultant on call that I'm bringing this 20 yr old man to OT (I know he has very little chances to survive but it's either we give him our best in the OT (surgical team open up the abdomen and arrest the source or intra-abdominal bleeding while anest team continue resuscitate him on table) or we can leave him in A&E, continue this half hearted resuscitation going no where but sure die, and at the end of the day proclaimed that we had 'done our best', too bad for the pt for he was not stable enough to be operated on! (don't make me spit! your best is not what I have in mind!)

to be continue....

posted by LT @ 11:10 PM