Sometimes, it's when i get calls like the one i had last night that i wish i had another career...another life...where i wouldn't be still awake at 5am trying to set a stupid arterial line...in case you wonder, setting an arterial line isn't exactly my forte...i never seem to be able to get it at one shot...go ask the nurses who usually finishes up the pink brannulas for arterial line....you'll get a unanimous "Dr Kathleen lah"...
So yesterday i had a full ICU...with one patient which was facing imminent death...a chronic patient who had intraabdominal sepsis in septic shock..on maximum triple inotropes and was only deteriorating further...so a DNR was issued...otherwise the other patients were relatively stable but they weren't going anywhere...i.e. there wasn't anyone i could send out...but it was still a busy day with procedures and procedures...but things were quite quiet after 5pm...
As usual, and as expected...there's always a calm before a storm...and the ward ppl don't call the ICU MO until like it's almost midnight...got a call from the ortho house officer at 11.30pm...said that there was a patient who desaturated and was on high flow mask 15L/min and his saturation was 80+% only...lovely!! his ABG was showing type 1 respiratory failure...so i went to see the patient..asked them to prepare patient for intubation...when i saw the patient..i was actually quite surprised to see that he was still alert and conscious and could still talk to me despite the fact he was tachypnoeic and dyspnoeic...then i saw his case note and noticed that he was an 18 year-old foreigner...i.e. illegal immigrant..no offence to anyone who strives for political correctness..but it's a well-known fact that the illegal immigrants are survivors...and they can be at the brink of death and still pull through and walk out of the hospital well and alive....it's in their genes...
I checked the patient's saturation monitoring chart and noticed that the patient's saturation has been low since 10am...and nobody did anything for him...oh sure, the nurse informed the house officer and what did she do? she just ordered for high flow mask and then went on with her deluded little life...there's generally a prejudice against illegal immigrants here but to disregard a patient who was in respiratory distress for more than 12 hours...i guess it should be acceptable for the righteous anger i felt...so i called my boss and told him about this patient and we decided to intubate him before he just collapses beyond help...
But even after intubation, it was very difficult to maintain his saturation...and i found out why he was in respiratory distress...he was having pulmonary haemorrhage...blood was just spurting out through the endotracheal tube while i'm bagging...suction didn't really help coz the blood just reaccumulated and his lungs collapsed each time suction was done...initially the plan was to send him to Queen side for ventilation in the ward since ICU here was full and he was an immigrant (generally, we don't take in immigrants into ICU coz most of them can't afford to pay)...but while waiting for the ambulance to come pick the patient up, my ICU patient died at 1am...so what do you know? suddenly, i had an empty bed...but it wasn't another hour before i could take in this poor boy...and we couldn't put him on the portable ventilator coz he would desaturate (which meant that he couldn't be transported to Queen anyway)...so the house officer and nurses had to bag him till we were ready to receive him in ICU...
So by about 3am, we finally cleared and prepared the bed...and so the boy was brought into ICU..put him on the ventilator with high settings...100% oxygen and saturation was only 80+%...thank God he was young...so his blood pressure was still stable..but he was pale due to the bleeding...and his heart rate was constantly at the range of 140-150bpm...had to sedate him to keep him from fighting the ventilator...and i spent the next 2 hours trying to set a bloody arterial line for him...i just hate it when that happens...you have no idea the amount of cusses i cussed (in my head) the whole time...i finally decided to give up when Grace (the OT call MO) came into ICU..thank God she helped me to get the patient's arterial blood gas...the result wasn't pretty..and the patient's lungs were really bad...but well, as expected he was still alive and his saturation was actually improving by the time i handed over to the next person on call..i wouldn't be surprised that he'd be already extubated by the time i go back to work tomorrow...and yes, i'm bloody on call again tomorrow...
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