It was not an easy call....I was entering the ED door and someone outside was shouting, "We need a trolley please !". I saw a person in a orange working suit - looked like a coast guard; there was a green car beside him. I met one of the ED nurse sending patient to ward while I was walking toward the ED that means there would be only 1 nurse available. I grabbed one of the trolley and pushed toward the green coast guard petrol car. The coast guard open the back door and pulled someone who was wet through out from the car. A middle-aged male who looked cyanosed. I asked the coast guard how did they found him while we were transferring him to the trolley. The coast guard said he had fallen into sea at the port. I took a quick glance and noticed he was not breathing nor moving. While we passed the counter I told the counter staff to broadcast a code 999.
The patient was rushed into the resus area and Lem joined me there. I grabbed the laryngoscope, ET tube and BVM and intubated him stat. I violate the standard Intubation Sequence - no bagging, no stylet, no jelly. With limited ED staff - I had developed this skill...some may critised my technique but I could get it in successfully with 1 trial most of time...Well, CPR was commenced and asystole was noted on the monitor. However the difficulty to get in a line, 3 nurse from the ward came to help and unable to get a line. The patient vein look just like those IVDU but no prominent needle mark noted. I tried the rt femoral vein with a long veno-cath and got it. Then I walked out from the resus room and asked about the history. There were 3 persons who claimed themselves as patient's friend and 3 coast guard member. They claimed that he was sitting beside the sea port and fallen into the sea. The coast guards told me that they rescue him instant and not more than 3 minutes was used. I asked about the journey and they said about 5 minutes. I estimated the time was 10 minutes o.n.o. The patient skin condition confirmed the history. The hand and foot skin was ok. The body temp was 32 degree C on arrival. Eventhough the patient was rescued instantly but the responsed was bad. The first ROSC was noticed at 10 mins and lasted only 20 seconds. The 2nd ROSC was noted at 20 minutes and lasted for 2 mins. Then everything was flat line..I concluded the resus at 52 min. The body was warm to 34 degree...and I was sweating eventhough it is winter now...We used the heat lamp to heat him - we do not have the warmer for IV fluid....
During the CPR, I overheard the arguement between the friends and the coast guards - one of the friend had questioned about the coast guards fast and rapid transport to the hospital without doing any CPR. The friends said," if you told me that you all cant do CPR then I would do it...", the coast guard was trying to pacify him. Later when the patient's brother arrived, he asked me if any CPR was done prior to arrival and I told him the facts," I don't know as I did not see what happen prior to arrival." The truth ? - definitely no...Who wanna do mouth to mouth resus to a stranger but in fact they could do only chest compression CPR.....I think there would be a scandal if this incident was brought to the media...
Most of the govt agencies in the area don't do CPR for the DOA patient. I had encountered few of them who did so for their victims. Reasons : incompetent senior...The senior member of these agencies did not perform their duties properly - they just packed and sent....so it will be difficult for the junior to follow....
Somewhere in my heart I hope this incident to be brought up by the media....but frankly said, I don't want to be involved in any scandal so better keep quiet...
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