I'm an idiot...

I'm back in Queen this week and next...and then i'm off to Gold Coast for a week...woohoo!! now would be a good time to have that remote control 'God' gave to Adam Sandler in the movie 'Click' and fast forward this 2 weeks...yea well, wishful thinking....

Anyway, i was on call again yesterday...had an empty bed...coz the uncle on that bed had died the day before...somebody punctured his lung during a pleural tap...boss said we hastened his death coz he was on his way anyway....the morning was quite uneventful, except for procedures... afternoon was busier...one patient went for tracheostomy...another went for 3-phase CT abdomen... thank God i'm on call..so i didn't have to escort...hehe...but one of the patient desaturated...and boss did lung recruitment on him...instead of improving, his lungs got worse...his saturation dropped even further... so we had to sedate and paralyse him to take over his ventilation...boss asked to call his relatives to inform DIL...urgh!! i hate informing DIL...

So i told the patient's mother and sister that he was deteriorating fast and he might not make it through the night...and boss and i actually expected it as well..and i thought to myself, this guy is only 27, younger than i am..sigh...but then we dialysed him and extracted 3L and then plasma exchanged him...and guess what? a MIRACLE happened!!! his saturation improved from 80+ to 95%...and his blood gases improved...oxygenation improved...and he survived through the night...and boss came this morning and said, there is a God after all...hmmm...WTH??!!

Anyway, about 5pm, i went down to check on some ventilated patients in FMA...then a medical MO showed me a 75 year-old Chinese lady with premorbid history of hypertension, diabetes and chronic kidney disease...she presented with upper gastrointestinal bleeding, anaemia and uraemia...he was worried about his patient...coz she might need dialysis that night itself...he said he was showing me the patient in case they referred for ICU admission for dialysis at night..i was like, WTH!! admit her now while i have an available bed and dialyse her ASAP...urea was almost 50, creatinine was 600 over plus she was already encephalopathic...and the nephro team said KIV for dialysis coming morning if urea and creatinine increasing trend...WTH!!! want to wait until patient collapse only come begging for ICU bed is it? then only wanna dialyse the patient when she's on triple inotrope is it?

So i brought her into ICU...initially couldn't set the central line and dialysis catheter coz the initial coagulation profile was abnormal...so had to transfuse fresh frozen plasma first..i repeated a coagulation profile on admission to ICU...it was bloody normal!!! wasted the FFP..and my time... and patient's time as well..coz she was acidotic and uraemic..and she was having some arrhythmia...anyway, finally got to work with setting all the necessary lines..but i gave aunty 50 mcg IV fentanyl and 3mg IV dormicum...and she went apnoeic for a while..i was an idiot...could actually see her saturation dropped from 100% to 50% plus within 5 seconds...i was like, bring the intubation trolley..put her on high flow mask..and i was slapping aunty on the shoulder and chest to wake her up...then about 5 seconds later, her saturation picked up to 100% and she was snoring...phew!!! she did look like a difficult intubation...obese, short neck, double chin and all..anyway, put in all the lines and called the dialysis staff to get her started on dialysis...

She only started her dialysis about 1am...and her chest x-ray was done around that time as well..when the film came back it was about 2am...i looked at it and thought..oh shit!!! i was actually worried that i may have cause a pneumothorax when i inserted the central line...and then there was an artifact on the film caused by some appendages which made me thought that aunty might be having pneumothorax...although her saturation was 100% all the while..blood pressure was high..blood gases were excellent...but i was an idiot..and i was paranoid...and i had no one else to ask...but i was worried she might collapse...coz another aunty developed shortness of breath but we managed to settle her...so i didn't want another problem...so i thought, ok, i'll try to aspirate and see if air comes out...so i did, 3 times..but nothing came out..so i guess it wasn't pneumothorax after all..and i was praying hard that i wouldn't puncture her lung and cause another pulmonary haemorrhage...anyway, by 4am aunty was still well and alive..and i (and my nurses) were about ready to collapse anytime soon...so i went to sleep..telling my nurse if the aunty desaturated, just yell...

When boss came this morning, i showed him aunty's chest x-ray and like a fortune teller, he asked me if the patient had a reservoir bag on her...the high flow mask she was on had a reservoir bag...i felt like a total idiot...embarassed to the max...thank God i didn't end up killing that aunty...sigh... moral of the story...don't ever put patients on high flow mask if you're inserting a central line and doing an x-ray on her...it will only lead to more trouble if you're the only medical officer awake at 3am in the morning and you can't differentiate a reservoir bag from a pneumothorax on a chest x-ray...i'm an idiot!!!