It was a calm
night shift until I expanded my portable army bed preparing for a good night retreat at midnight. Just after the setting up of my bed, I was called to see a patient came in for chest pain. The initial EKG12L had
ruled out myocardial infarction and he was treated accordingly. The first round of pain killer combo however did not resolve
the pain and I had ordered an aortagram to rule out aortic dissection.
As I was stepping back into the call room, a police had brought in a patient complaining chest pain.
The police claimed that he had run amok around the village and finally calm
down after a chase. They had stressed that they did not used force to apprehend the
patient. A friend that came in with them had however said that the police
had forced him down from the roof. He had added that the patient was his
construction co-worker who came from the east side. A relative had introduced
the patient to him and had withheld that he had psychiatric disease.
The patient was
tachycardic and normotensive. A immediate EKG12L was done and no sign of
ischemic change. I had used to accept all the history input even if they were contradicted each other; I presumed that he had
sustained trauma and most probably had an injury to his chest as his abdomen
was flat and no tenderness was noted.
While preparing
him for a CT with enhancement (he was 2nd place in order awaiting the completion of the aortagram), another patient
had presented to our ED. The patient was diagnosed as acute myocardial
infarction and referred to a hospital up north for intervention as requested by the patient. On
enroute, the patient had desaturated and the nursing personnel had decided to
stop over at our hospital for further management.
Patient was
irritable due to hypoxia and the initial bed-side sonography had revealed poor
cardiac contractility and pulmonary edema. I had to intubate him prior to emergency
percutaneous coronary intervention. His BP had crushed after the intubation as
expected and I had to insert a central line and infuse dopamine to hold him
long enough to the cath room.
It was 1+ hour
later when I came back to see the trauma patient. He had looked paler and his
abdomen had bloated. Apparently he had internal bleeding I had started another
round of resuscitation in ED for this trauma patient. As the first patient, he
was intubated and central line was inserted plus a load of blood product.
During the
resuscitation for the 2 patients, their BP had reached a low of 30mmHg and with
aggressive intervention, both of them had made it to the cath room and OR. The
traumatic patient had proven to have a splenic rupture later by cat scan.
The other patient
was a dud...after concluding three of them, I had managed to sunk into my bed
at 5:45am...It was 20 minutes later when the swamp of morning patient rushed
in....
It was a exciting
night; with only 2 nurses and a aide, I was able to get the appropriate job done
despite of the manpower issue. I just don't know how long can I keep myself in
this shape to tackle similar scenario...
At my age, I am at
the verge of going downhill, learning had become harder for me due to aging;
however I thank the great one for his kindness to allow me to go through all
this thrill and excitement...
