Saturday, February 14, 2004

My morning in resus started in the usual manner, with a slow patter of stable patients ( gastroenteritis, superficial forehead laceration, minor road mishap ). At 9:30am, however, the situation changed dramatically, beginning with our first standby case for the day -- a 46-year-old lady with diabetes, hypertension and schizophrenia, found collapsed at home. Asystolic at scene, blue and flat on arrival at the ER. Intubated stat, CPR, near impossible IV access that took 4 people and 15 minutes to obtain, finally getting a subclavian line using a green plug. 6 Adrenalines and the full vagolytic dose of Atropine later, we called it. I met the deceased's siblings and in-laws, who grieved yet managed to thank us for trying to save her. In the midst of all this, another standby called in, apparently an 80-year-old collapse.

A number of ambulance cases got downtriaged, but an additional MO was diverted from consult when a 78-year-old man was pushed in, sporting a 15cm gash across his anterior lower neck. Self-inflicted with a chopper, the paramedic shouted, as we transferred him to the trauma trolley. Bubbling was seen from an opening in the middle of the whole bloody mess. Likely the trachea, my consultant said. An ETT was inserted via this route with success, though he subsequently poured out blood through the tubing. I was sent off to speak to his distraught family -- a son, daughter-in-law and grand-daughter. He looked depressed recently, but gave no indication of suicidal intent. He'd mauled himself when everyone was out, only to be found when his daughter-in-law returned from the market.
Systolic BP 90 despite aggressive fluid resus. Dropping into the 80s with each repeat BP check every few minutes. The general and ENT surgeons were paged and rushed down immediately. "E" blood was infused. A quick update from the ER physician and surgeon, and the patient was pushed up to OT, doctors and nurses running by his side. As I walked by the trauma room in the wake of this exciting ( albeit gory ) episode, a health attendant was picking up bloodied pieces of gauze, mopping up the scattered pools of red, the sudden silence and lack of activity feeling oddly abnormal.

The rest of the shift passed by in a blur. Fractured pelvis, PV bleed in an elderly bedbound woman, viral gastritis, non-specific exertional dyspnoea... if only they were as straightforward as they sound! Most patients presented atypically -- pain out of proportion to the actual injury, only confirmed when the x-rays came back normal; a lady claiming a history of coronary artery stenosis, but old notes documented a completely normal dobutamine stress echo; the bleeder found to have blood on her diapers, initially thought to be per-rectal in origin, but is actually per-vaginal in nature. I reviewed so many old notes my head began to spin, and getting a history out of each person was absolutely exhausting. Now that it's finally 4pm, I'm overwhelmingly relieved. I can't wait to go home. :)

And by the way, that 80-year-old standby collapse never did come to the hospital. S/he may have perished at home, or as one nurse suggested, woken up. Oh well, you never know. :D

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