Phie Phie's Blog

Sunday, July 09, 2006

Eventful Sunday morning!

Last night, we handed 3 patients to the night staff (1 came at 9plus so the night staff took the case so total was 4 patients). The moment I stepped in this morning, I didnt see the E- cart, I heard voices of doctors and nurses... in my heart I was thinking "SIGH... must be busy last night!" I looked at the monitor- WAH total of 6 patients. The night staff admitted 2 intubated patients and 1 of them is quite sick. I was prepared for a busy morning shift!
It was already 9am by the time we finished our routines, then came the on call registrar Dr T. He told me he is going to pace a patient... I told him if it is not urgent he will have to wait for all of us to finish our break which is 1030am hehe Dr T always get bullied by us because he is easy going.
After break, I quickly finished up my reports and settled my 2 intubated patients and assisted Dr T with the pacing. Fortunately my 2 intubated patients was rather stable hence dont need much attention hehe... Before we can start with the pacing, one of colleague's (Chun chai) patient BP dropped tremendously. Dr T was busy ordering drugs for Chun chai's patient (started dopamine, dobutamine, nor adrenaline, adrenaline, N/S, Dext 10%, bicarbonate 100mls, numerous stat Dext 50%, hydrocortisone stat, fortum stat blah blah blah even ordered swan ganz insertion!), so many that I cant really remember what did I put up for him! While we were busy in the room, the patient that was supposed to pace arrived. Dr P alone was with the patient in the pacing room started with the sheath insertion. Dr T was still stucked with Chun Chai's patient, he dont know whether to insert Swan for him first or to pace the other patient first!
In the end we all agreed with pacing the other patient first because it seems to be more straight forward. Before pacing, he inserted a femoral sheath for Chun chai's patient to run those drugs that he ordered, yeah, the patient definatlely needs a better IV access. (HOW to run with just a BLUE plug???!?!!!?!?!?)
Thereafter, I assisted him with the pacing and it took about 45mins, fluro time of 2.7s. Great, sent the patient back and proceed with bedside Swan for Chun chai's patient. Attempted numerous times but failed through the jagular and subclavian! Dr T told me "Hey, think uh... ehhhh... got to send patient to fluro room!" I was like "HUHHHHHHHHHHHHH"!!!!!!
Patient intubated, 6 terumo pumps, lots of drips hanging..... HUHHHHHHHHHHH!!!!!!! Sigh, what to do, we sent the patient in to the pacing room, by the time it was like 150pm. Fortunately there were more staff to bring the patient to the pacing room. With my tired 4 limbs, I assisted with the Swan insertion... Dr T did it rather fast, he railroad through the earlier femoral sheath with the fluro time of 1.7s. It was around 215pm when everything was done so we brought the patient back to the room.
THAT WAS NOT OVER! For less than 5mins, patient collapsed, went into VT/VF! We shocked him with 200J then patient went into asystole! Chun chai did CPR.... then followed by Dr A.... still pulseless so they continued. I was diluting adrenaline, given patient total 8 bolus of it. I told myself "HOW CAN THIS HAPPEN! DID SO MANY THINGS FOR THIS PATIENT THIS MORNING AND HE IS GOING TO DIE NOW???????? NOW???? OF ALL TIME, NOW??? JUST AFTER INSERTED SWAN!?? AFTER GIVING ALL THE DRUGS????!!!! ARGGHHHHHHH"
BAE TAHAN! I told Dr A "Hey you tired with the CPR, let me do!" I did "agressively" and after about a min, I heard Dr T said "Ehhhh ehhh ehh like got output! Stop CPR and look at the rhythm!"
BRAVO! Sinus Tachycardia with the BP of 125/60mmHg!!!!!!!! WAHAHHAAHAHAHAHA STEADY! SWEE!!!!!! PHEW, the morning staff can finally go home!!!!!

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