Yesterday was really quite an exciting call...as usual the day was pretty mundane...i found out that the fish bone uncle died at midday on Monday...and i also found out that his sepsis didn't just set in within 2 days...apparently he had been in a district hospital for a week before he was finally referred to Queen...yes, me such a poor history obtainer...
So anyway, apparently i'm destined for dramatic night life when i'm on call...whole day i didn't have any admission...about 8pm plus, my boss in the elective OT called to enquire about the availability of ICU bed..apparently an elective splenectomy went wrong...17 year-old girl with a huge spleen and liver...liver was accidentally torn on mobilization...bled bled bled and bled...got the spleen out (i saw the spleen...it was a foot long) and packed the liver in the hopes of stopping the bleeding... patient came to ICU about 9pm...initially BP and pulse looked quite stable...but she was pale as sheet... managed to get 2 more pints of packed cell and 1 DIVC cycle...so was transfusing like mad...but then her pulse kept increasing and her BP kept dropping....started on IV noradrenaline and the dose kept going up and yet unable to maintain her BP...and she was becoming paler as i watched her...shit!!! she was still bleeding...called the surgical MO on call who came and scanned splenectomy girl's abdomen...damn!!! free fluid in the abdomen...
Had to prepare her for op again...good thing i already sent for another round of bloods and blood products...but even cross-matching had to take an hour...got splenectomy girl to OT about 12am... managed to get her 4 pints of packed cell and another cycle of DIVC regime...as if trying to stop her bleeding liver and resuscitating her wasn't dramatic enough, one of the surgical MO had to collapse halfway through the op...too bad i wasn't there to witness the drama...but from reliable sources, i heard he apparently had some kind of 'fit' and went unconscious...what i had problem believing was that everyone rushed to this surgical MO's aid while leaving the splenectomy girl bleeding intra-op...but the surgical MO woke up and thank God it wasn't the splenectomy girl's time to go yet...after the surgical consultant came in and spray coagulate the bleeding part of the liver and re-packed it, the bleeding seemed secured...
Splenec girl came back to ICU close to 3am...on maximum double inotropes now..they've transfused practically all the bloods intra-op and she actually looked pink again...continued to transfuse the remaining DIVC cycle...managed to taper down the inotropes...i supposed the bleeding has stopped since by about 5am we've managed to off all inotropes and her BP was stable at around 105/60mmHg and her pulse hovered between 125-130 bpm...but being the paranoid i am, i didn't go to sleep till about 6am...finally convinced that she's no longer actively bleeding...
Got up at 8am and went out to see splenec girl...still pink...BP and pulse still stable..phew!!! you have no idea how relieved i was...handed over to the MO on call today...went for breakfast...then came home and crashed till 5.30pm just now...sigh...i don't know how much more of such dramatic night life i can handle...
the surgical MO that collapsed intra-op just had to call my husband his BFF at 6.10am to tell him about that episode!!
ReplyDeletehahahaha....i guess when in trouble, we always remember our BFF yea? pity jerome...
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