Hope for the best

The heat had built up again since the last raining episode and it was “summer arrived” day when I did my 10-10 shift. It was quiet until an ambulance call which brough our attention. A traumatic OHCA patient was being sent over to us and we had prepared the resuscitation area for the patient as usual.

An elderly male was pushed into the ED with the LUCAS on his chest and LMA in his mouth. I was not the designated attending physician to the case but as usual, I stepped in for help. While my junior colleague doing a FAST echo, I had moved to the head side and started the airway replacement. No rapid sequence medication was needed and I removed the LMA and found out blood secretion was filled over the oral cavity. The intubation was smooth with the aid of Glidescope. A great tool but yet over relaying on such tool would definitely spoil one skill. After the intubation, I swapped my glove and did a PE. A right femur fracture was noted. Within minutes after the airway alteration, pulse was noted. From my past experience, swapping the LMA to endotracheal tube was a crucial step as most of the time, the LMA does not do what it should have; the most significant evidence was the follow up chest xray post intubation which would reveal a severely bloated stomach. Securing the airway was the crucial step for return of spontaneous circulation from my experience in the past.

While we continued with the survey, I heard our triage nurse brought in a lady to identified the patient. I was shocked when I saw the lady; she was wife of our ex-colleague QF. It could only mean on thing….the patient is QF. I quickly take a good look at our patient again and spitted out the 4 letters word starting with F in my heart.

My heart sunk as I resumed my position at the head side of the bed preparing for the central line insertion over the neck. It took me under one minute to complete the procedure and all I could do was prayed as I am not the attending physician. Normally the attending would complete the procedure, but in this case, I just stepped in.

I knew QF for more than 2 decades. He was the senior maintenance technician of our hospital and we had helped each other during the past few decades.

His wife had told us that he had gone for a hiking trip around the mountain area today morning and was hit by a superbike during his return.

The CT revealed intracranial hemorrhage and pulmonary contusion. Our senior neurosurgeon on call was reluctant for the surgery but yet I had urged my junior colleague to ask for one. As usual, the orthopedic surgeon would go in if the neurosurgeon wishes to go for surgery even if something as simple as an icp monitor placement. The latest ATLS had prioritized the management of circulation and pushing for surgery had become the top mission. My colleague had done a great job pushing for the surgery.

QF’s condition was not stable as he was put on double vasopressor during the surgery. A drain was placed despite the ICP monitor and the brain damage was worse than what was shown on the imaging. Luckily the fracture was fixed without difficulty.

He was still 3 over 15 today morning when I visited him in the ICU. BP was still less than 100 despite double vasopressor use.

Later today evening, he was able to furrow his eyebrow when I called him; tapering of vasopressor was done as he was more stable.

I hated it when I had to attend to whom I knew as I realized the fact that the final result relied upon the great one.