Palmo Anest

Long crazy day

I was oncall the other day, it was a public holiday. When I arrived in OT at 7:55am, there's already a patient waiting to be pushed into OR for ortho surgery. So I started the case with my post-call colleague passing over in OR and then do a quick ICU passing over rounds with him and the rest of the on-call/post-call team.

My OT has been going on and on case after case non stop till about 9:40pm. That's when I finally took my dinner. After my dinner, when I was explaning the progress of one of my 'ICU permenant resident' to his relative, I got a call from surgical that we have a case of stab wound in A&E who needs immediate operation.

I went STAT to A&E with 2 14G branular with me. Went there secured extra IV access while arrange for Intra abdominal and possible intra thorasic surgery. The victim were stabbed twice on the back and the fatal one on the lower right thorax which lacerate 2 segments of his liver, transected the right kidney, perforated his duodenal and cut some of the unidentified larger vessels.

We transfused 4 unit of blood in A&E while waiting for transfer to OT. On arrival in OT, we set an arterial line for invasive monitoring and the Hb after 4 units of blood before the surgeon opening up the abdomen was 5g%. He continued to bleeds on table and by the time we finished the laparotomy, we'd transfused 14 units of bloods and 2 courses of DIVC regime. He was on both Dopamine and Noradrenaline intraoperatively.

HB on arrival in ICU was about 3g%. Chest tube drained 4400ml of frank blood. BP even lower, added dobutamine and later adrenaline infusion. Continue to pour fluids and blood and blood prodcts. Seems getting no where... Pupils became fixed and dilated.

I finally touch my bed at 4+am. Just before 6am, a MI patient with APO admitted CCU and was reffered for ventilation support. I called up the experienced CCU staff to ask for patients condition, was reported to be better after lasix. I didn't see the patient untill I wake up in the morning! (Guitly! but i just can't drag myself out of the bed till my morning shift colleague came into the call room!) Luckily the patient is really ok and doesn't needs ventilation...

OTOH the surgical patient continue to be very bad and we giving up on him after the morning round after reviewed by the surgical team.

We play GOD but we ain't GOD!

posted by LT @ 1:28 AM