it was this evening when I just took over the shift...there was this call from the local a rescue dispatch channel - MVA with 3 victims ( 1 was Death on arrival).
We were prepared when the case arrived. The DOA was a young man with tattoo, there was another person on trolley who looks alert. But I did not see the 3rd victim. A local samseng came in and pointed at the DOA telling the registration desk that the DOA was XXX and the other was YYY.
The DOA was rushed into the resus room. My senior (fellow Malaysian, nephrologist)had just walked pass the ED, he took the other one and told me to concentrated on the DOA. There was blood spreaded all over the DOA scalp. As usual, CPR was commenced and I intubated him stat. As the nurse was trying to get a line, I did a primary survey over him. There was no wound over the scalp despite the blood. There was this mandible fracture and blood was coming out from his nose and ear...skull base fracture. The blood was pumping like spring as the ambu-bagging commenced. The nurses had to put a suction is his mouth for continue suction of the blood. There was difficulty of getting a line. Needle mark was noted his ante-cubital area - an IVDU. The neurosurgeon came by with his NSP and both of them sworn that they knew the patient as his tattoo look familiar. The tatto was over his anterior chest and abdomen, 3 devilish head was noted.
There was subcutaneous emphysema and I inserted a chest tube over each side. Still PEA and no response. I ordered some blood but still no sign of it after 15mins. Then someone told me that the family had come. I left the patient to the team and approached this couple ( middle-aged, husband and wife). I asked them who they were, they told me that they were XXX's parents. I broke the news that the patient was noted with DOA and currently no responsed was noted. The mother cried ," I couldnt bare to see my son in this state" and almost collapsed. The father helped the mother to the seat where she could rest. I returned to the scene and continued with the CPR. It was 20+ min with no response despite all those tubes I inserted. But there was still no sign of my blood...
I finally gave up at 30+ mins. The lab technician came in and told me that he had doubt with the blood test and he wished to request for another sample but unfortunately he was too busy to call us...I almost burst out with the 6 letter work started with KN....I told him never mind. I then proceeded to the parents and broke the news...The mother fainted on the spot. After settling the mother, I went back to the computer desk and look at the records. There was another victims and was managed by my senior. The 3rd casualty did not registered though.
While I was completing the entry of the DOA victim. There was this loud shouting outside the hospital. I went out and had a look. The father was shouting at the samseng with those KNNxxx words. Appearently the samseng had given the wrong name to the registration desk. The real XXX was standing alive outside the ED. The death victim was ZZZ instead. The mother was so happy seeing the son alive....well, I slipped away from the scene...part of my fault, never insist they take a real good look at the victim.
I got a call when I was back at the desk. The lab technician called me that he was not going to issued the CBC data at it look very weird. I asked him was it the hemoglobin value ? He said yes...I told him to just issued the report without asking him about the value. I had known that it would be very very low - indeed the report showed Hgb of 2.5g/dl. Still not the lowest - I had seen Hgb of 1.7 g/dl from a person walking a live. It was a young female with schizophrenia. I saw her many years ago. She had presented to ED with dizziness and she looked damn pale. I repeated that check twice. I did a very detail history taking later. Appearently the patient likes to poke her anal with chopstick and bleeding was noted.
1 hrs later, I broke the news to another mother, she came with her daughter and both of them looks so calm....well, imaging an IVDU could do to his family - not surprise with their response....
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