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Monday, October 23, 2006

Difficult Airway II

The other day, while I was running elective list, my colleague running the emergency OT called me. Went out to the reception area to see what's going on...

Lo and behold, this is what we have (I have the patient's permission to use his photo as education material).



His ThyroMental Distance is only 1 finger breadth. We proceed with caution.

We explained to him his risk and also our options if we can't intubate him. Then he was induced with propofol and test ventilated to make sure we can ventilate him with face mask. Then my colleage did a lanryngoscopy and found that it was Cormack Lehane Grade IV.

I took the McCoy blade and do another laryngoscopy and this time it is Cormack Lehane III with a good cricoid pressure. After confirmation of the laryngoscopy finding then only we gave suxamethonium followed by intubation without any problem.

Post operatively, we informed him again about our finding and tell him to inform his next doctor if he had to go under another GA in the future. Who knows he might came in late at night and some heroes might book him for a GA case without notice the airway. It might just cause unnecessary stress to the anaesthtist at the wee hour.

Selamat Hari Raya Aidilfitri

Selamat Menyambut Hari Raya Aidilfitri!

Maaf zahir dan batin.

Saturday, October 21, 2006

Lets celebrate DeepaRaya!

Happy Deepavali and Selamat Hari Raya to all!!

Difficult Airway
Recently we received a distress call from a private maternity centre for help.

A young lady going for elective LSCS for a so called big baby. After induction of anaesthesia, she was not intubatable, some problem of ventilation too, SpO2 remained about 80% while they tried repeatedly for almost an hour, manually ventilate the patient.

Our team, an anaesthetist, an anaest MO and an O&G MO went with ambulance to transfer the patient to our setting.

Our team reversed the patient and keep her on spontaneous breathing with high flow O2, SpO2 was only about 92% along the transfer process.

Emergency trasheostomy under local anaesthesia was performed. However the patient was already aspirated and developed ARDS few days later.

In the mean time, the baby was delivered with vaccume extraction later. The little one was ventilated for a few days ad later succesfully extubated and still under paediatrician's care.

She was later transfer to state ICU where there is an Intensivist and the other subspeciality. I heard that she is weaning off trachy now.

Thursday, October 19, 2006

Master Program

Have waited for this for a long time. Finally I've been confimed in service thus eligible to apply for my master program.

Sent in my application today. It's either make it or break it. If I got it, I'll still stay in service,otherwise it'd be off to private practice next year.

No point staying as chronic MO any further if not getting into master program.

I like my current job. I like anaesthetic, I like serving public hospital, but my family deserve a better living...

Monday, October 16, 2006

Little Napoleon

Today I have met our local little napoleon in the hospital. She is our administrative clerk who had been very notorious.

I finally got my confirmation in service (Pengesahan dalam jawatn) after completing 5 years of service. (no thanks to the little napoleon, if I didn't went down to Putrajaya last year, untill today still don't know what went wrong). Anyway, that's another story.

Since I'm confirmed, I'm eligible to apply for local master programme. During the process, I found out my SKT for year 2003 was missing so I asked my boss to re-write a SKT report for year 2003 for me. My boss did it and gave me a high 9x.xx% marks. When I summited the report to our datin napoleon, she REJECTED the report and said:

'How can it be so high! You were only 1st year in your department in 2003. How can u get such a high mark? I'm already serving 30 years and just got 90+% this year! Ask her to re-write a more realistic mark!'

Bugger...

This is the mark my direct boss gave me, had nothing to do with your 30 years in service and only got 90.xx%. Look at how many complaints u little napoleon got from all of us for job not done, missing paperworks etc... It is already a big surprise for a 90% for ur SKT! If I were ur direct boss... u'll get a 69%!

Bugger... Now, go back to work! Dun shit!

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