to helmet or not to helmet....

It was tiring morning..... I was post call and I got a phone from the combined ED down south..

"We had a case of head injury with SDH and we wished to transfer him to your ED", the doctor talked to me over the phone with Cantonese slang. (Hong Kong with ROC citizenship...). I agreed to his request as the ICU was quick empty ... I asked him what was the GCS and wheather the patient was intubated and this was the reply :" The GCS is 6 but he is breathing smoothly, so I don't think he need intubation at the moment...".

What a professional answer I got.... this was what the local people down south derserved. A special fund was set up to upgrade the service the ED service - the doctor was paid RM100/hr and these kind of doctor was hired....

The patient arrived 1 hrs later and there was a nasal airway in his nostril. I took a glance at the CT. The hemorrhage was minimal but there was severe midline shift. I told the family, ops was needed and I needed to intubate him stat.

The guy had short neck and small mouth - short than mine...I tried the oral approach and failed. I did a second look and still failed to visualized the vocal cord. I decided to go for the nasal path. I was lucky as the patient was still breathing heavily. I passed the tube successfully during my first trial. Well, he was up to the OT within 40 min . That is the advantage of a small hospital ... fast and efficient of clearing patient from ED.

I obtained the history and found out that the patient had fallen from his bicycle. He had gone to the famous Kenting beach town with his wife and children. They were doing a joy ride in the morning. Unfortunately the person who rent the bicycle did not provide helmet. He had fallen and knocked over his head... The history had reminded me about a news I saw 2 days earlier - a police who took part in a bicycle ride with his chief. The unfortuante policeman was cycling down a slope a loss control. He was riding with full gear but the speed was too fast and he sufferred from intracranial hemorrhage and cost him his life...

Well - better stick to my helmet(my head ...) and Strida(not the efficient but slow is safe...)   - I am doing my ride consistently and I dont want to end up like anyone of them....