da so called "rice cooker" - simple home care ventilator
Our hospital had been facing ventilator shortage since few months ago. I am not sure about the cause… boss had told us during the morning meeting that the hospital is currently under the subsidiary scheme of the health department and every purchase over a certain amount would need to go tender…the tender process would take times… and it had been sometimes after the meeting and the condition had become worse during the Chinese new year…there was this 15+ years old Drager Evita ventilator posted in our ED. However due to shortages, the ventilator was moved to the ICU.
I had did a few resuscitation with the aid of ED. In a small hospital, we had limited staff to manage the CPR scenario. 1D2N in the night and with 1 person on the chest compression and 1 person on the BVM, the other would have to act as runner for the drug administrating and charting.
No one seems to care and whenever I saw there the Drager Evita was not in the resuscitation area, I prayed very hard. The LORD is indeed full of mercy as I had escaped and had enough sleep on most of my shift. However I finally hit the rock few shift ago. It was a bad night – the ward was calling and patients kept coming to ED as if it was free of charge. The ICU had informed that a patient had been experiencing shortness of breath. I ordered an ABG and it revealed a mix respiratory and metabolic acidosis. The respiratory therapist had told me no ventilator was available not even a “rice cooker”. I ordered some sodium bicarbonate and told the nurses to review the patient later. By 3am, the nurses had told me that the patient had again noted with dyspnea and this time, stridor was heard. I told myself – what the heck...I had to intubate him. I passed on a tube without difficulty and told the nurses that we would take turns bagging the patient. Each of us bagged for 15 mins. It was 2 hrs later when the patient was stable enough to be hooked onto a T-piece…
Sarcastic episode – during the early 2000, when I was doing house officer call in my home town general hospital, I had intubated a COPD patient who went into failure. I remembered the medical officer yielded at me telling me that there was no ventilator available and I should have “ask around” before I passed on the tube. That night, the staff nurse and attendant bagged the patient with me until morning…
Yet, I had recreated the scenario ….some had come to me and asked me why I joined the bagging – I told them that I make the decision for intubation and I should be responsible for the consequences…..Another yet – the management still pretend their “so far so good” attitude….until last week…
The was this 80+ years old male who was sent to us by the local ambulance, noted with a forehead laceration. He was unable to tell me how he had fallen despite being asked specifically about the event. I ordered a brain CT and a large subdural hemorrhage was noted. I called up the neurosurgeon as usual and after informed him about the case, I told him no ventilator was available. He asked me to try to “squeezed” one out for him. As usual, nothing can be “squeezed”…. The only option was transferred the case out and I told our surgeon about the result and he had wanted me to talk to boss again – boss was informed prior to my call. When I called up boss- he told me no problemo, 2 ventilator is coming in by noon….really need some kicking from the cash cow….
That ended the ventilator crisis…
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