After the joining
of our 5th staff, life was better but however the quality of night
shift had gone down. We were being harassed q10-15min most of the time by
nurses. The fee of RM 50(all in, no partial burden) is considered cheap to the
locals as it is just walk in and seen by doctor without extra
waiting(especially in the night). Of cause the health insurance covered an
additional RM140 medical fee to the hospital (simple flu, stomach upset with no
examination done).
Most of the ED
physicians are not afraid of those critically ill cases as when they stepped
into the ED, you could tell everyone related that the patient is so ill that he
would die. The most horrifying patient is those that walked in and deteriorated
out of your expectation.
Lem had left me a
patient yesterday. An old lady with mild abdomen pain for few days. Lem had
told me that she is case of diabetic nephropathy and had undergone a partial
hysterectomy with bilateral opphrectomy 2 weeks ago at a big hospital at the K
city outskirt. An KUB was obtained which revealed markedly distended colon. Lem
had ordered a CT before he left. I took over the case and review the CT later.
The CT did not reveal any significant finding apart from the colon distension.
Her white count was rocking high at 19000 and Creatinine had worsened from
2.0mg/dl to 6.0 mg/dl. Despite of her status of afebrile, everything pointed to
the direction of septicemia. I told the family about the result but the patient
had opted to return to the “big hospital” up north for further treatment. I
told the family that although she looked stable, she is at the risk of sudden
death. The patient had however decided to transfer despite of my explanation.
The final check vital sign before her transfer had shown a BP of 55/30mmHg. We
approached her and she was fitting. We rushed her to the resuscitation area, I
had a moment of hesitation to intubate her as she was still breathing but
drowsy. She was bradycardic on the monitor. I ordered 2 epinephrine but no
obvious improvement was noted. I ordered 2 vials of sodium bicarbonate and her
heart rate was stabilized and regained conscious. After the event, the family
had decided to stay back and patient was sent to ICU. She passed away later
that night….
Family had accepted the situation as there was time for the family to accept her condition.
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