Sunday, March 22, 2009

On call scare...

I'm on call today...and i had quite a scare this morning...they posted a 17 year-old girl for EUA and T & S under GA coz she had a bilateral parasymphysis fracture of the mandible and a dentoalveolar fracture of the right maxilla and some laceration wound..the girl, let's call her A, was involved in an accident yesterday night when the motorcycle she was riding collided with a bus (not sure if it was a stationary bus)..but i supposed she was darn lucky to have escaped with just the above mentioned injury and a closed proximal 1/3 fracture of the right femur..

So anyway, i started the case without much thought...the dental team wanted nasal intubation..after inducing her, i proceeded with the intubation...i inserted the nasal tube into her right nostril (really, what was i thinking?)..it went into the pharyngeal area after some initial resistance but when i was trying to view the vocal cord region, all i saw was blood pool...i think i traumatized her soft tissue while inserting the nasal tube so it started bleeding...i couldn't see the vocal cord coz of all the blood..then patient desaturated and became bradycardic...had to manually bag her till her saturation picked up again...thank God for my MA...i was quite panicky and i couldn't bag properly..so he took over and managed to intubate A with an oral tube...but A aspirated some blood somehow...

I called my specialist to come in coz the dental team still wanted nasal intubation...so my boss came in and tried intubating the left nostril but he couldn't get the tube to pass into the pharyngeal region...we guessed there was probably some injury around her nasal region as well...so anyway, they settled for the oral tube and proceeded with the surgery...boss decided to send patient to ICU post-op coz she aspirated...

So i learnt a lesson today...next time if i have a patient with facial injury, inform boss and ask boss to come in for help..oh, another lesson...do not think i'm smart enough for my own good....no one's infallible...

3 comments:

  1. It's all in a day's work, my friend.

    ..all in a day's work.

    It's still better than sitting a a desk from 9 to 5, unless of course you're trading shares during that time.

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  2. Hehe...get that alot too here in USM. Bloody hard to anaesth peeps to nasal intubate patient if got facial # wei!Somehow someway, always got some kind nasal injury. Maybe should call in ENT to check before proceeding ;P
    hehe...We dental people ma fan ho ? :P

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  3. yea pang..i know...but i just need to 'ventilate'...hahaha...i don't think you'd want to be doing a 9-5 even if you're trading shares..
    thanks taptrick..the ruling out nasal injury should have been done even before patient was posted for any op..no lah, dental ppl are actually the easiest ppl to deal with..in OT at least...

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