The Grim Reaper strikes OT...

Yesterday's OT call began disastrously...up till yesterday, i have managed to avoid a DOT (death on table)...it's not something i brag about to anyone but i was always grateful that no patient has died on table when i was giving gas...but my bosses have always told me that you're never truly a GA MO until you have a DOT...so yesterday was my last OT call as a GA MO...

I started my call with a neuro case...not exactly the best omen...aunty was 63 years-old...ASA 3 with DM, HPT and CRF requiring occasional dialysis...apparently she had chronic subdural haemorrhage which caused her to have left hemiparesis...GCS full...they posted for burrhole and drainage...the MO said, it's a very simple op...and i have done many burrhole and drainage...there was no reason for me not to accept and proceed with the case...

So aunty arrived in OT at about 930am...i assessed her...she was talking and smiling to me..she could answer my questions with full comprehension...i guess she didn't know as well that her last conversation would be with me, the GA MO...so i put her under, intubation was uneventful....the neuro MO started the op at about 945am...BP was stable throughout...but she was steadily bleeding...only had 1 pint of blood...about an hour and a half into the op, her BP suddenly dropped to about 80/40mmHg...good thing i had the right mind of setting another large bore brannula for her before the op started...so i started running gelafundin and warmed up her 1 pint blood...after 2 readings of low BP, her BP picked up with fluids...

When aunty's BP dropped, the neuro MO asked to call her senior for help...so another neuro MO came in...and they decided to convert to craniotromy...about 10 mins into the craniotomy, aunty's ETCO2 dropped drastically...fell from 30 to 15 then to 7 then to 2...and then her saturation became undetectable...i thought her ETT dislodged to i checked but her ETT was in place, the tubings weren't disconnected, and the ventilator was giving good tidal volume...i called my boss and he came immediately...i told him blood loss was probably 800-1000ml...initially BP responded to fluid...but after her ETCO2 dropped, her BP became unrecordable and she became bradycardic... we started running the 1 pint blood and asked the nurse to trace the other GXM she had from the ward...

Boss asked to set arterial line so i was feeling for her dorsalis pedis pulse...could feel it feebly initially, then suddenly i couldn't feel the pulse anymore and boss said, patient went into asystole...shit!! so we asked the surgeons to stop and proceeded with CPR...gave all the necessary drugs...even defibbed her when she went into VF...but after more than 1 hour of resuscitation she was not revived...i felt so horrible when i had to explain to aunty's daughters that their mother was dead...

I didn't cry though this time...i think the shock hadn't really set in...boss said it was probably pulmonary embolism...the sudden drastic drop in ETCO2 strongly suggested that...it's such a rare operative complication...but it had to occur to this aunty during my call...i can't help feeling responsible for her death...if i hadn't accepted her case and proceeded with the case, she would probably be still alive...perhaps it was a jinx...not that i'm particularly superstitious...but perhaps if it wasn't me who was on call yesterday, then aunty would not have been my 1st DOT...but i couldn't have known in advance yea? yet the ugly truth is...aunty's dead...and i'll never forget her last smile...