bitten

It was a last day of the "cold front" night - supposed to be a peaceful night - at least the "small night" shift(4pm-12MN) was... I had a 999(a.k.a code blue) and I managed to get a ROSC after 15min of effort...A CVP was inserted as hypotension was noted. After the CVP, I went back into the blanket and wished for a good night shift the rest of the night. But by wish lasted for only 10 min - > "ETT cuff leak noted with bed I X, might need a re-intubation...". I gladly complied and went back to ICU. The patient was struggling as the nurse tried to remove the ETT - no a good sign : "S n R" (struggle and resistance)...
I ordered a propofol - if muscle relaxant was ordered, the nurse would have to take a long time(ran to ED ... it was the hospital policy to keep it in ED and OR only) and  propofol seem to be a  good choice at the moment - and I was wrong....

  I waited for the patient to calm and introduced the blade... the patient suddenly awaken and started his "S n R" tour. He had caries and lost half of the tooth and the blade had sunken into one of the gap and my right index finger was bitten following the sink.... Luckly no wound was done but I had a bruise over my index finger's nail bed....

darn ... 3rd time since I got my license, reminded me to insist for muscle relaxant next time....

Best employee award again...

It had been 1 year and the election was on…Unlike the other hospital I work in. The best employee award was generated by election. The staffs vote for the best nursing personnel and the best employee…
Well, as the last year award holder, I was barred from being voted for the next 2 years. The nursing list was not surprised as the winner came from big unit(means unit with more than 10 staffs). These unit can “request” their member to vote for specific person in the unit….
The best employee winners went to some ‘rover’ … those who roved around the hospital…
The polite rover would attract enough vote as other staff would have a good impression on them...(I am a rover as well, I roved around in the night...)

well, a little bit unfair and much more to be improved, But I still felt that every winner deserved the award as they really work hard..

bone problem...

I had tried very hard to keep myself update on my job, however sometimes, I had doubt…. Thank god, someone had invented something called the internet.

We had this osteomyelitis case who was referred to a medical center for further management. There was a great chance for the patient to get the disease as she had rammed her bike into a drain and the bone was soaked in the drain for sometimes before she was dragged out. A simple trauma case who undergone surgery in our setting...

It should have been ok eventhough osteomyelitis developed. However we had pushed ourselves to the current ground. Proper communication was not done pre-ops - no one had explained the risk to the family. When the wound broke down and pus was pouring out from it the family was still hoping for a forever remedy - the family was polite : I just don't care how you all fix the problem, just healed the pt.... 

 The implant was removed and however a plate was re-planted on the second debridement. And weeks after discharge, pus was noted from the scar again...Well, this time, the patient was referred to a bigger hospital up north ... and more shoking news came later -osteolytic lesion was noted (so rapid...) . We reviewed our film and found that no xray was repeated on the latest admission...well, the worst is not another suit as one of the close relative of the patient was a ex-convict ( man-slaughter....)...

For a moment I was a little bit shock when I heard the whole story as it was not the 1^st time for the attending doctor to do so…(the last pt expired after a severe noscosmial infection) .

I had a discussion with Lem and we had re-confirmed over the net that the concept of removing the implant in an osteomyelitis situation was appropriate.

It is impolite to criticize our colleague…but I still felt someone should talk to him…..