Resus and SHXT

A CPR/resuscitation scenario is always a thrill in most of the TV series/ movie, but in actual life, it isn’t. One of the main concern is SHXT and PXE ( feces and urine)… In about 1/4 of the case, patients(either with sign of life or not) are incontinence. You just have to tolerate the smell. The nurses wouldn’t try to clean up the mass if no sign of life was noted. The 30 mins scenario is sometimes a smell tolerance game.

Well, I had this middle-aged psychiatric patient sent over by the local asylum after she collapsed. A lady with BMI of >40…as usual she was intubated but I told my nurses that prep the ETT anyway, I said there is a 50/50 chance the tube is in the stomach.(but in fact, their record is 100% esophagus intubation…).

The patient arrived and as I had predicted – I had to re-intubate her…The nurse who came with the patient told me –she was seen in a hospital nearby for Acute gastroenteritis earlier that day. She was soaked in her own feces…I had to do my job…I certified her after 15mins later…

I remembered the film “silence of the lambs”, when Jodie Foster and Scott Glenn entered a Autopsy scene – they had applied some whitish cream over their upperlips to barricade the smell of the degraded corpse….Just wander where I could get those….(tiger balm won’t work…I tried it during my days in the casualty department as coroner)

the next wave....

one of my favorite movie....

I had finally finished the coding of drug… 450+ of them (it is really small amount compare to the 10000+ items of the National Taiwan University Hospital). The interface for the drug data managing and nurses drug dispensing are also readied. The nurse could just click the mouse and all the photos of drug for the patient would be shown on the monitor. The program is time specific, if the current time is 6:00pm , only the drug given on the time would be shown. The nurses won’t have to double check the drug with the pharmacist if they were unsure about the appearance of the drug.

However there are still 3 great challenges lying in front of the project. The 1^st is the photo, I got about 200 drugs with photo and the quality was unacceptable. I had coordinated with the art supervisor of the hospital and she agreed that she would get a desktop copy stand and take the photo for me. But I had to communicate with the pharmacist and get all the sample labeled and pass it over to her. Communicating with the head pharmacist is a problem as he had always been a stone head.

The 2^nd challenge is setting up the testing ground. I had did a preliminary discussion with both the matrons(we had 2 now- 1 for he critical unit and the new one is focusing on the ward)- the ICU would be the 1^st to run. But I would have to communicate with the attending physician and surgeon that all prescription would have to computerized –no more hand writing. Someone would definitely grumble….

The 3^rd challenge is to introduce the scanner and modify the dispensing trolley. Scanner and bar-coding are simple technical issue but the dispensing trolley is more complicated. Batteries, wireless LAN should be included and the MIS dept is currently still in limbo. They are still busy upgrading some of the window 2000 terminal to window 7 as I had upgraded my develop platform from VB 2005 to VB 2008…

An amateur trying to create a user friendly interface for an existing system .... I am alone and I felt like sailing into a series of giant waves – this would be the most gigantic wave ever, there are so many things that are new to me….

I hope I could make it through with FAITH…

 

 

we pay for them...

I had been trouble by those stimin seekers lately. I do not consider this bunch of suckers as addict as no craving is noted. They used stimin as “interlude” drug- to sedate themselves whenever they had no money to buy heroin. The benzodiazepam group of hypnotic had no effect on them (one of the reasons – almost everyone of them are heavy drinker and).

The oral route had is not adequate for them – they crushed and grinded it into find powder and injected it into their vein.

Some of them with history of pancreatitis would come in to ED complaining of epigastric pain and minutes after the injection given(I usually start with cimetidine), they would start to request for “Demerol”. I would usually told them to be patient and wait for the amylase level. If the level is elevated, I would admit him and give whatever to ease his pain. But unfortunately, 1/10 chance I would get a normal value. I would then politely told them, no one would ordered me to give any narcotic drug. After a few time, they would not come in if they saw me at the desk.

However lately, I had covered the Ortho OPD(surgeon gone for ops) and met his scum bag. He had still 6 pcs of stimin left and he came for asking more. I told him that the computer prohibit me to prescribe such drug to him as he had still medication left(I had to lie…). The scum bag had told me that he would bring his kids and asked to prescribed for the boy after he had spend 15mins begging, threatening and cursing in the clinic.

I was lucky the surgeon came back and I handed over the clinic back to him. The surgeon did not prescribed stimin for his child (thank god…)...

A stimin worth less than 20 NT but  it’s hypnotic effect which could get the addict through the craving stage make it priceless….and the health insurance paid for it( so sarcastic….)

 

crucial.....

Lem had given up his night shift….He told me after he negotiated with boss. Actually he had seen boss to submit his resignation. He had got an offer from one of our senior around the place he stayed. However when boss heard about the bad news, boss had asked to stay back – taking off all his night shift.

Well, if the request was brought up 12 months earlier, the management would have told Lem to find a job elsewhere….well, the situation had been so hazard…

Well, Lem had stayed back, for the moment…

The breaking ground ceremony of the new building would be held 2 days later….

The management had offered pure ED job(means the ED physician does not need to cover the wards complaint) currently … I had smelled and got hint from the management that they had planned to post us to the ward as night shift doctor if they got a team to take over the ED ….well, it would be sayonara then. Some of the regional hospital had posted ad for night shift attending physician/surgeon for years and not one interview had been set up... the reason is simple, someone who had the capabilities to do general ward calls, could easily cover the ED job, so why get a job which paid 40% less.

Well, the situation is obvious – we are currently(maybe for the next few months to one year…) crucial to the department…I had asked Lem if he had asked for raise and he told me no- he felt sorry as boss had to take over his call…indeed boss did more night shift than me this month….