The morning was relatively normal for me who was tagging in the red zone, while the yellow zone (where Nu'aim was) was completely swamped with unnecessary admissions, which I'll refer to later in another post. But all that changed when I returned for the afternoon.
First, we had some new patients that came during lunch break. But the morning MO didn't pass over the cases to the new MO, so we had to orient ourselves with the old cases on our own. Boss told the afternoon MO to help out with green, while the morning was finishing the morning work. As the morning MO was supposed to still be around, we expected her to handle the red zone while the afternoon MO dealt with patients in the green zone. While doing that, we were suddenly thrown into the frying pan. Mind you, all of the bays in the red zone were totally full.
First, a brought in dead patient (BID) was brought into the red zone. MVA, young adult, open fracture grade II of lt femur, ENT bleed visible. While documenting that patient, another came in. Middle age with chest pain, previous history of AMI with balloon angioplasty done. The MO was busy helping with green. The morning MO went to observation bay (OB) and literally "disappeared", so I had to clerk the patient.
While clerking the patient, a patient was transferred out, and another promptly transferred in from ambulance call. Young adult, eyes dilated and fixed, asystole; I assumed that the patient was BID as well. He was an industrial worker, who suffered injury by a machine falling on him. The MA asked me what to do with the patient, and I told him never mind as he's dead already. But I did promptly told the morning MO, for which she told me to tell the afternoon MO.
The afternoon MO was shocked as there was no proper passover, so I briefly told her about the BID patient, for which she (wrongly) decided to resuscitate. We even intubated him. Of course expectedly the patient wasn't revived. But I noticed that bagging the patient became progressively harder (I was in charge of the airway). The doctor also said that the bagging sounds were faint at best when she auscultated. I took a few seconds remembering anaesthesiology lectures. That's when it occurred to me: Shit! This patient has pneumothorax! And shittier still, none of us (MO, medical students, MA & nurses) properly examined this patient (we were still disoriented with the current patients, so were unprepared for new patients)!
I stopped bagging, and palpated the chest. Oh fuck, it was like a leather bag filled with hyperbaric air. Percussed - hyperresonant like those hollow watermelons.
"Dr, I think this patient has pneumothorax la."
The doctor palpated and percussed, as did the others. We gave her a gray (large bore) needle which she used to puncture the right pleura. Gas followed by blood. Bilateral tension hemopneumothorax.
Then we also noticed that his crotch was seen pretty big. We opened it up, and noticed a huge scrotal swelling. Intraabdominal injury. Then it occurred to us that there was also flank bruising. During intubation we also noted a mandibular fracture. We stopped resuscitation. Polytrauma, and anything might've caused his death.
I then reported about the patient with chest pain, and of course the MO was surprised. While going to attend that patient, boss asked us about the BID patient, for which she then scolded (especially) me and the MO for trying to resusc. a BID patient. In the middle of assessing the chest pain patient, another came in. Elderly in coma, hypoglycemic but not revived with dextrose. Family members not around (yet). Argh.
We tried to intubate him so that we could do a CT scan. I tried first as the MO offerred, and I forgot to assess the airway first (neither did she). Only while attempting did I notice that he was Mallampati IV! With TMD less than 6 cm.
As soon as we finished securing that patient, we saw another patient already in! Turns out that she was transferred from yellow zone, but the MO didn't inform us first (as we're busy resuscitating the BID patient). Elderly with apparently lowish GCS (even though the yellow zone MO said that she was 14/15, but we didn't listen to a proper history from the MO as we're busy already; yellow was also overflowing by then). Ooh, we were all well pissed off by then, and the afternoon MO was literally calling the morning MO to settle and pass over the morning cases (which we still knew almost nothing about yet in the red zone).
While being pissed, turns out that another was already in as well! 34 years with IHD, in for chest pain. I attended him, while the MO attended the elderly lady. As soon as we finished with both, the MO decided to review the morning cases by herself. Turns out that a morning patient didn't even have his blood taken. And no review ECG (k/c/o IHD, came in with SOB). Damn. I took the blood and ECG's of patients that required them, while the MO tried to review the morning cases and report the new patients.
Then she asked me to review the patient transferred from yellow. We were told that she had 14/15 GCS. Huh? E1, V3, M5 is not 14/15! While she tried to review the history taken by the yellow zone, I finished up the bloodtaking and ECG's.
5.30 pm, and I decided to call it a day.
And the worst part of the afternoon was that when I initially came into the red zone, the boss was with the HOD of medical dept. Something was wrong. PPE was ready to be used. I asked one of the MA's, "Ada suspected case ke (of H1N1)?"
He nodded. The patient was in the quarantine room, and while we're busy doing our thing, the boss was attending that patient with full biohazard regalia.
Lessons:
1) Always properly pass over/refer your patients.
2) Always properly expose unconscious patients with incomplete history. You can have med students and nurses+MA's to handle resuscitation, while the Dr makes a quick examination.
3) If intubation is done properly but still something is amiss (regarding (B)reathing, never ever forget pneumothorax (stressed by anaesthesiologists time and time and time again, as well as ED MO Dr Jeth)
4) Finish your work so that the next shift doesn't have to play catch up for you.
5) Serdang ED needs HO's. Like now. You can't have medical students who can't give input into the hospital IT-based recording system being the main (medical) helpers of the MO's.
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