13 January 2011

Bad Call!

Assalamualaikum :)

Yesterday, i had a very bad call. It was a disaster!
3 vehicle accidents took place in Sekinchan and Tanjung Karang, occured around pretty the same time.. 9pm. It involved 7 victims, if I am not mistaken. But I hadn't calculate the less injured.

Around 8.30pm, I finished settling a case in ward about a patient complaining his knee pain which already been there since 1 year. He wanted pain-killer that night, so he can sleep. Guess what did I give? Hehe, just knowing that he had a lot of medical problems with kidney not functioning well, I gave him MORPHINE! IV Morphine 2.5mg stat (small chicken dose, though), hope he found dream in his sleep.

Then, I became wonder, why my wife hasn't come back to our oncall room since evening. For your info, me and my wife had oncall together yesterday. She covered the Emergency Room, and I cleaned up the mess in all the wards (got 3 wards actually- male, female & maternity). We shared the same oncall room, since we are legally husband & wife, so that's ok, rite? ;)

I had a sense that my wife had troubled there. Usually, covering Emergency is very relaxing. But there are times when things can go so bad..

So.. I went there. As usual, I saw a number of patients & family waiting outside. Looks 'normal' to me. As I arrived there, our ambulance has also arrived. Rushing a patient on stretcher to Red zone. Quite bad, but seem fully conscious. Ok.. that's still pretty 'normal' to me.

But, then the things started to turn out 'differently'.. and badly. More patients came in, with multiple injuries and moanings. Some of them were brought in by people. The Red zone was already fully occupied (Hehe, we had only 2 beds for Red zone). The Yellow zone was loaded with more and more 'red' case. In a moment, the Emergency Room has already filled up with accident's victims.

That's to me was NOT normal.

In the Red zone, I saw my wife, struggling to intubate a patient. The patient was a young guy, but had big laceration on his neck, or should I say it was like the patient being .. slaughtered!

Very scary. If we removed the compressive bandage on his neck, the blood will gushing out and the patient will definitely died in an instant from hypovolemia. But still, patient was responding to pain. So, Midazolam had put him rest a little.

Intubation succeed, by our experienced MA. However, blood pressure started to drop (90/50). Ops..! That's what I afraid for. His heart race also was racing (120). That's definitely sign of bleeding a lot. But where? No other injuries seen. Chest looked normal, expanded equally well. Abdomen has no sign of injury, like bruise or wound. All limbs doesn't seem to have any fracture. Waiting for xray would take ages to recognize any life-threatening fractures or injuries. Rite? At that moment, we depended solely on our examination.

Failed to detect any source of bleed, we gave him a total 2 pint Gelafundin and few pints of saline/Hartmann. Lucky, his BP and HR showed improvement. That's a big relief, at least our fluid resus still worked. Waiting for blood is not possible within 30 minutes, in such case.

Fuh..! Having successfully managed that patient, is quite a satisfaction. But, it was no time to relax. There are still 6 more patients to attend to, with 2 of them had very clear-cut sign of internal cranial bleeding (drowsy, persistent profuse vomiting, signs of head injury). If I let them here a little longer, I will ended up having intubate both of them as well. Huhu..

We rang the 'emergency bell'. We called up for back-up. Any MA available were summoned, and doctors staying near to hospital were called upon for assisting. It was a disaster.. It really is..

Forget to mention, almost all of them had some fractures.. femur fractures (one of them had bilateral femur fractures!), tibia fractures, radial/ulnar, etc. Even though looked stable, but those fractures are known to cause a lot of blood loss, isn't it?

Without much hesitation, I called Emergency Hosp Sg Buluh. I talked to the MO covering the Red Zone about the severe accidents that took place, and they accept 3 patients. Phew!! That's really a big help.

Thanks, Emergency Sg Buluh.

If you had not help me, one of the patient might died here definitely. How are we going to handle our situation when 7 victims were severely injured, 8-9 victims with minimal injuries waiting outside and more than 15 'normal' patients are still pending outside for long time.

Luckily, we managed to send those 3 critical patients. The others.. I left for my wife to handle. Not because I am lazy, but Labour Room had called me up for 1 patient with extensive blood loss after delivery (another Post-Partum Haemorrhage?, I thought), and 2 new cases for review. Ohhoo.. It is the Labour Room that I scared the most in my hospital. Not because it is 'haunted' only, but it is where cases like maternal mortality are. And.. maternal mortality is a BIG thing if you are a doctor. Probably the scariest responsibility of a doctor. Once you had a mortality case, you basically screwed up! You might get expelled from profession if you were found guilty.


That's what I had yesterday.
That's why I hate oncall.
Because I am Jonnah!


zoul dahan said...

I thought my day yesterday is the worst.
Luckily, your day is even worst.

Thank you for sharing.
I feel a bit better now.

He he he.
This is life.
Jonnah made you stronger.

aYa said...

rindu suasana casualty la fatir..aku dah x melalui episod sebegitu..
mesti aku dah x pandai intubate, set long line etc..huhu..

DrSatriaN said...

Aya : Ish.. mehla datang sini. Ganti saya. Saya selalu dapat palpitation jaga Emergency, lama-lama dapat sakit jantung nanti. Huhu.
Zoul dahan : Yap, but unfortunate for me, it is not the end. Huaa... the Jonnah will cursed me for another 2-3 years. Huaaa..

Daddy Ziyyad said...

aku tak suka duduk kat A&E.

ER masa aku practical dulu kat sydney, mmg beza gila dgn A&E kita. A&E kat district hosp memang menakutkan, bagi aku lah, when it comes to major disaster like yours last night.

nurin said...

jonnah tu pe? dasyat jgk..xsangka abg fatir ni keje dr yg mcm ni punya woww!!! xsangka...xsangka..ish3.good job. as sister, agak proud sikit.hehe

DrSatriaN said...

Jonnah tu.. macam label kepada seseorang yang bila tiba waktu kerja dia, keadaan tempat kerja dia jadi sibuk memanjang. Bila dia ada, banyak pulak pesakit datang. Bila dia takde, pesakit pun sikit. Ibaratnya camtu le.

zoul dahan said...

Sepanjang saya kerja kat gomen, saya tak pernah Jonnah. MA kat A&E suka kerja dengan saya sebab patient 'takut' nak datang kalau saya on call...

Untuk elak jadi Jonnah, kena doa selalu sebelum on call. Kena baca2 ayat2 pendinding gitu...

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