CNY case 1 - "transfer also die and no transfer also die"

I had this 2 “extra-ordinary” cases during the Chinese new year.

The 1^st case was a 60+ years old female who had fallen into a drain about 1+ meter high. She had opened the backdoor of the kitchen and miss stepped into the drain. She was sent over by the ambulance with full immobilization gear. The patient had complaint of bilateral hand numbness. She was however unable to lift her lower limbs and drop wrist was noted. She was alert and denied of any loss of conscious. It was a spot diagnosis and I told the family that she had this cervical injury with spinal cord involvement. I told them this is a life threatening injury and the patient’s younger brother had told me straight that they want a referral. I told them I would referred her once the examination is completed.

The initial management and CT took about 35 mins and it was a C7-T1 fracture with subluxation. I called up a medical center up north and they accepted the case. I told the family again that I couldn’t managed her here as our neurosurgeon is not around. I The BP was fine on arrival and started to sloop down just before we moved her. I ordered a dopamine drip and flush in 1L of saline. I had also given her a mega dose of hydrocortisone. The patient had left the hospital after lightly 1 hour on arrival. The nurse had however called me up 15 mins later telling me that patient had gone into hypotension and loss of conscious on the way. They had stopped a nearby hospital and resus was done. The patient was intubated but however did not make it through the resus. The family had asked some sharp question and queried about the decision of referral made by us at the nearby hospital and the doctor over there was kind enough to tell the family that the patient condition is destined and referral is a must as it is the only hope for the patient.

The younger brother who was residing in our area and came to me the next day and asked me again about the referral detail and I told him that if my neurosurgeon was around, I would have objected the referral request and would do everything possible to keep her as ops is the only hope for her to survive. The brother had seem to do some asking around and agreed with my explanation. They had thanked me on the way out and appreciated what we had done.

I was lucky as it might end up as a medical legal suit as cardiac arrest on en-route would be the referred doctor responsibility….well, ass save and reminds me to do my usual “transfer also die and no transfer also die” speech(I was too busy during the period and didn’t told the family about this --- my fault…), I hated this speech as it make the family panic and very disturbed while making referral decision, but still I won’t have to clean my butt (and prepare for jail house…) if I do so...