 |
|||||||||||||
 |
|
 |
|||||||||||
 |
 |
||||||||||||
Everyday is a learning day...and today was not different... I was given the responsibality to take care of the periphery patient today...not something I would like to do all the time, since its pretty stressful...my surgeon, senior MO's were not in...and I had to consult a few other specialists regarding management of some of the cases, especially at ICU. It's always important to call for help even though you think you know what is best. Knowing what you think is the best does not always apply the same for other people, some people have more experience and I don't considered myself very experienced in the field of surgery...I've just been here for 2 months! Another very sad incident happend in the ward today...pt came in very bad, had massive UGIB, requiring ventilation, scope done, bleed stopped...but then rebleed suddenly and crashed in the ward. Since she was ventilated, not many people took much attention to the Low BP, until it was really low...tachycardic...resusitation really started when my surgeon dropped by to notice that her vitals are not stable...fluids went in..., slowly manage to get blood and bloods went in...she was already on ionotrops...(that was the mistake), we later proceeded to manual bagging was saturation did not picked up, BP was fluctuating like crazy, IV lines were bad...we had to go into femoral, next lines...evetually...she passed away...we barely had much time to explain to the family...and she crashed so badly...probably another massive GI bleed... 1) When BP is low, don't start ionotrops first, see if her fluids is adequate, accertain her cause of low BP...ie low intravascular volume, sepsis...or heart failure. 2) When resusitation, never forget the ABC's...airway, though intubated, if saturation if not picking up, check ET tube, suction to clear airway, bag manually. Circulation, get IV access fast before the patient collapse fully...the larger the canula, the better it is... 3) Dont' just stand there...do something...no point have 5 doctors around, when no one is not leading the pack...one person must take charge, the senior most should do that...waiting for the surgeon to come and take responsibality is a big mistake, you have to take charge first. It's hard to say in the end of the day if we could have or not saved that patient, not to mention she is 84, premorbid having a hip fracture which was just repaired 11 days ago... did we try our best? did we detect the earlier signs...there is room for much debate... Post a comment in response: |
| © 2002-2008. Blurty Journal. All rights reserved. |