It was a busy
night and there was a long list of pending being seen was noted on my computer.
A man in uniform was rushed into the ED by EMT from local mountain area.
A police man in
his 50s was crying loudly for help. The patient was hysteric screaming about backache.
He was like a child who cannot reasonable his parent refusal for his wishes.
Patient was paraplegia and his lower limbs was flaccid and movable. Back pain
with paraplegia had limited our differential diagnosis. I had called an
immediate CT scan with enhancement without waiting for the renal function test.
A lax anal tone
was noted after Foley catheter insertion and confirmed my suspicious of spinal
cord involvement.
Worst of all, he
was bradycardic and complete AV block was noted.
The CT revealed a
type B aortic dissection and nothing could be done here.
Patient was intubated
and ventilated with fluid support via central line and inotropic agent for the
crushing BP that noted after the CT scan. A temporary pacing was done for the
bradycardia. Apparently the dissection had involved artery supply to his heart
and spine.
It took me a whole
hour preparing him for the transferred. The ambulance arrived minutes after his
wife came with his colleague. His condition had improved with his limbs moving
and he was more conscious with all the life support effort we provided.
2 hours later, the
nurse accompanied the transferal had come back and told me that he collapsed
instantly on arrival at the tertiary facility.
It was double jeopardy
for me; QF and this policeman. We managed them promptly and we had done
everything we could but yet, patients did not have a good outcome.
QF had noted with seizure on D4 and we knew that he would not wake up anymore. The policeman had collapsed despite of our effort.
Right diagnosis, prompt management and ....
still not our call for the result..
I hate this job sometimes...
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