Palmo Anest

New Year, new post.

Well, it has been very long while I didn't post.

I think I need to clarify sometime here to do some justice to govt medical service. Those of you who are not 'insider' in medical services might get very anxious as peppermint energy posted here. But I'm not telling the truth and the whole truth...

Basically, things that creat much emotional stress that I need to vent out are usually some negative stuffs. However there are actually a lot of good stuffs happening in govt hosp in daily basis. Probably as a chinese, I'm not so used to express possitive feelings... maybe. :)

Anyway, let me illustrate 2 recent cases that happened in one of my oncall days that actually make us feel good and these are part of the reasons that keep us in the service.

Mr S, a 23 y.o. young man riding his motorbike back from work like any other days. Like many young motorist in Penang, he was riding his bike at high speed, going back home. Somehow, for some unknown reason, he lost control of his bike and crashed onto the divider. Brought to hospital A&E department by ambulance service.

On arrival, he is conscious (GCS 15/15), in severe pain especially over his abdomen and hip. His initial BP is normal but getting worst minutes by minutes. Both Surgical and Orthopaedic team was consulted. He has and intra abdominal injury and a pelvic fracture.

I (Anest team)was informed by surgical colleague and went to A&E to assist in resuscitation and prepare the patient for immediate operation. By the time we bring him to OT, he was bearly conscious and was very pale (due to the massive blood lost)but BP holding (due to the fluid resuscitation done in A&E). Surgical team went in 1st and he had multiple intestinal laceration, messentric artery tear, splenic rupture which was corrected on table and severe retroperitoneal haematoma which we can't do much. Itraabdominally packed with abdominal packs. Ortho team then went in for some debridement, T&S and skeletal traction.

He was transfused 7 pints of blood and 1 set of DIVC regime intra operatively. He is still in DIVC when we transfer him to ICU post op. Ventilated and continue post op care in ICU and we removed his abdominal pack 2nd day post op. At that time he is still in coagulopathy and ventilated with high PEEP due to ARDS caused by massive blood transfution. We manage to bring him to OT with ICU ventilator which support him with high PEEP. 4 hours after the 2nd surgery, he bleeds intra-abdominally again and needed a 3rd laparotomy. Again we rushed him to OT with the same ICU ventilator, ligated the bleeder and came out confidently that this time there won't be any more bleeder if we corrected the DIVC.

He finally was discharged from ICU after some 3 weeks+ stays and has been discharged well from the ward. A young life was saved and back to his love ones.

The 2nd incident, Mr F, a 22 y.o man again riding motorbike back from work met with an accident with a trailer truck. When the ambulance went to pick him up, he was still stuck under the traler's wheel. Rushed to A&E and was immediately resuscitated, and refered for immediate operation. He has sever crushed injury to his left lower limb and hip fracture. Degloving injury of his entier perinium including his genital organs. Intra abdominal injury, retroperitonial bleeds and some lung contusion.

To cut long story short, it was very chalanging to keep him alive on table itself but we manage to mantain him and surgical team packed his abodomen. He went in for 2nd laparotomy and repacked the abdomen together with amputation of his left lower limb (high AKA). He was subsiquently went for 3nd laparotomy and debridement of his wounds few days later with an ileostomy done on him. Over the course in our ICU, his DIVC was eventually corrected, ALI resolved, septic shock resolved but unfortunately his wound still very bad and get MRSA infection, there's almost no healthy skin left below the unbilicus.

He was already extubated and breading on his own that time. Lucky for him plastic surgery take over his care and his wound is healing well now after they did full thickness skin grafting on him. He was another 'long time resident' in our ICU who survived and cheated the death.

So, it is not always the bad things. There are many goods in public hospital too... probably more goods then bads, open our eyes and we will see the goods! (and try to eleminate the bads).

This is LT, reporting from Malaysia Public Hospital.

Cheers.

posted by LT @ 11:36 PM