drug overdose.....

I had these drug overdose cases yesterday...

The ambulance had rushed in a male alleged with drug overdose. The patient was in semicomatose state and SpO2 was 90% on O2 nasal cannula use. The breathing sound was coarse crackle bilateral. The wife who came with the ambulance passed me the medical slip. I took a look - 3 type of Benzodiazepam drug plus Prozac and Sulpyride. Well, he had taken the whole 3 week dose. I asked if he had vomited in the house and the wife told me yes. Great - drug overdose with aspiration pneumonia , I need to intubate him stat...I put him on a mask and passed on a NGT. NGT irrigation had revealed blueish fluid..(one of the pill was blue in colour).
I told the family about the diagnosis and option. Nowadays ,the doctor don't choose for the patient, the patient and family make the decision pending option offered by the doctor. I told them that I could take him into the ICU but it would take at least 5 days for me to confirm if there is any other type of drug overdose as the lab test would need to be sent to some lab outside our hospital. The aspiration pneumonia make the condition worse...another choice was to referred him to medical center grade hospital. The family agreed with the transferred and I called up the 3 medical center in our region. None of them had ICU bed but they did not deny acceptance of such case. The family finally decide to go to one of the medical center. I intubate the patient before transfer.
Well, the patient suffered from major depression and had an arguement over a phone bill. Another waste of medical budget  - as a person who worked under stress: physical and mentally everyday, I couldn't imaging what those people who commited suicide had in mind....I remembered once Ving scolded me that I was a cold hearted Bexxt as I was calm when Yun was severely sick...I don't blame her, that is part of me since the day I chose this profession. I remembered back in medical school, my relative had asked me if I was afraid during the anatomy class. I said no, no because I am so brave, but we were too focus to dissect the body and learn the structure. The formalin vapor made us slow down on the dissecting process, we could hardly open our eyes when near the cadaver - we were constantly behind schedule. Later when I stepped into my internship, my first worry was could I made it overnight without any sleep. I was so happy I made it through my 1st call, then my second and so on.....
Well, there was another "drug overdose" that night. A bus driver had found a guy unarousable on the bus. The guy had slept since he boarded the bus and did not get off at his destination. When the bus made a temporary stop at the bus station near our hospital. The bus driver had attempted to wake him and he was unarousable. The local ambulance and police was summoned and he was ferried over to us for help. I found a 5 days dose of antipsychotic medication. He had taken his ON dose - 6 pills of 8 was gone(yes 8 pills on night....). Appearently, he had fallen asleep under the influence of his usual medication. He was not a case of drug overdose after all. The police helped us to contact the family and he was brought home safely. The father told me that he usually sleep ok after he take his medication. He did sleep ok on the bus...
Unlike those black and white cantonese movie which often feature suicide by taken sleeping pills and alcohol together. The sleeping pills today are relatively safe. Patient might have to take hundred of them to kill themself...well, safety mean less mortality and more medical expanses...

failed....

I had failed again...well, nothing much to say, a fail is a fail. Next year, I shall return...well, it would be held in Kaohsiung and less stress for me. I drove 220 km up north for the exam...well, another long distance test for my Z - it is a nice car, worth every penny....

When I saw the list, I was disappointed, but I had studied for a mere 2 weeks. I admit that I did not do my best on this exam and hoping that my experience would help me pass...but rumour said that it was not a fair examination but WTF, just focus on myself...

ACLS instructor course - pretest ......

I am going for my second trial of ACLS instructor entry examination this weekend. This time it will be held in Taichung, central part of Taiwan. I am a little bit nervous actually. ACLS had been part of my job and I am familiar with it. Passing it means a lot to me....well, hope my good luck continues..

driving safety .....

It was my monthly Saturday ED shift again...I am off most of the Sun and Sat but would covered an daytime Saturday ED shift once per months...well, slow and boring afternoon. I had just recovered from my AGE and disturbed by this frequent intestine movement which was does not cause any pain but produce this embarassing "KULU KULU" sound...

The ED nurse told me over the phone that 1 DOA (death on arrival) is coming over within 3 minutes. I got out from my bed, took a quick face wash and walked toward the ED. The 911 ambulance came just before I took a step into the ED resus room. As usual no cervical collar, no spinal board, no passing over. I had to asked the EMT how it happened while shifting the patient over to our bed from thr scoop stretcher. And the answer was - " I don't know, he was beside the car when we arrived. you better ask his friend outside." I did a quick primary ABCDE ... Severe craniofacial injury and rest of the body look ok. The head just a sealed plaster bed containning a broken vase and water. I couldn't intubate as the nurse passed me a laryngoscope with lamp that make the oral cavity look like a ghost house - dim light with unstable brightness. The oral cavity was filled with blood  and I thought the suction with need to suck for hrs before it would be clear. Brain tissue was noted over the nose and ear. I took a scalpel and did a tracheostomy stat. I knew it was hopeless but need to comply with the local situation - I just can't certify death on the spot when the case arrived as what I could have done back in Malaysia.  I need to do some resus ... and I cant ambubag the patient like that - with brain tissue and all the blood and the deformed head.... so I did a tracheostomy...
I left the patient to my team after securing the ABC and walked toward the friend. There was 2 friends sitting outside the bench. They told me that he was the driver(Suzuki Swift 1.5). The victim was spitting betel nut juice out from the window and he loss control of the car. The car than rammed into a field. The car was not severely damaged and the airbag(not equipped or malfunction ?) was not inflated. The victim had rammed onto the dashboard....I told them I would have to certify as nothing much I could do...The family had come hours later. After the explaination and hysterically reaction of the family the was this fight occuring outside the ED. 1 young guy was chased and assaulted by the victim's relative...I overheard the conversation later : the victim did not own a driving license and this young chap had rent a car for him to drive. The family was angried at the young chap for renting the car...crap la, no one point the gun at him to force him to drive....well, but the moaning relative got the privilege, so nothing much to say....insurance is not gonna pay a cent and that was the price the victim paid...

The photo below is bloody...and don't try it if you feel you can't take it.

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last chance to regret !!!!

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I did a second thought - this one is the less bloody version than the freaky big head view...remember : buckled up your safety belt and buy a car with airbag !!!!!!

medico-legal .....

There was this news today regarding a O+G doctor being charged... there was this lady with thyrotoxicosis G1P0 with twins pregnancy and follow up in a famous O+G hospital. The lady had a premature rupture of membrane at 31 wks. She later had acute respiratory failure secondary to pulmonary edema. The twins were delivered early but later expired due at 1 months and 5 months old respectively. The family claimed that the doctor did not intensively follow up the thyroid function test....anyway the prosecution decided to charge the doctor pending the investigation from the medical-malpractice committe...

Yet another typical case of lack of trainning...just 3 years of training and one could sit for the board...lack of medical and surgical training...I doubt the doctor could inteprete the thyroid function test...the O+G had become one of the thoughest branch in the medical society here - the insurance premium is high and lots of young specialist earning less than a medical resident...some of the specialist had switched line to do cosmetic....

I recalled another news few weeks ago...involving my ex-classmate. I am not very familiar with him - but he was one of the top in our class. Graduated and stepped into ENT(one of the hottest..) field in an local medical center. He had treated a child with otitis media and cholesteatoma with surgery and 10 months later, re-ops the child as symptom recurred. He had however "removed"(or over drilled?) the cochlear and injured the facial nerve. He did not tell the family about the removal and the child did not recovered from the facial nerve palsy...my ex-classmate is currently happily doing his PhD. in US P..burg university and the poor child suffering from hearing loss and facial palsy...I wander if he would come back...I did not agree with the hiding part - if you done a mistake : admit it , not hide it and prayed that no one could recognized the problem...

CNY eve shift again...

I was working on thei CNY eve again .... well, nothing much to say, my colleague parents is coming over from Malaysia to celebrate with him. So I did the shift instead...

The shift started from noon of CNY eve to noon of D1 of CNY. The call was ok initially but later in the evening, it become crowded in the ED. There was this viral AGE going on and quite a few numbers of such patients. It was quiet after midnight. I was awaken by this MVA - 2 guys on bike vs divider. These 2 guys were soaked with petrol and heavy alcohol breath noted while talking with them. One of them was a SOB who started his cursing right on the moment he stepped into the ED. I was irritated with his attitude but did not wanted to argue with such moroon...He was drunk but still alert. He was sent into the resus area for wound management. After finishing the paper work(computer work actually) I stepped into the resus area to see how's the suture going; appearent the suture was done and the surgical aid and nurse was trying to undress that guy. His pants was soak in petrol and they were trying to change it. The nurse suddenly pointed at the patients penis and asked the surgical aid," what is those mass over his penis ?". The surgical assistant told the nurse," it is iron bead implant to please women." The patient said in his usual sarcastic tone, " what iron bead - it is jade man, expensive one..." I shook my head and walk out...

The bead.....

Unfortunately the patient had an SAH and refused for admission. I had called his family and they refused to make any decision for him...he was still laying on the ED bed when I left by noon....

It was not busy but I was bothered by this phone call from the ward and ICU, q1h patient coming in for some flu and AGE... I was quite happy when I left - although tired, I felt the weight ofbonus and new year angpow from my boss in my pocket....also there is 3 days off waiting for me...

Next year I hope I would be back in Malaysia - I missed yee shang(raw fish salad....)....