Monday, 26 March 2007

Another busy day

Just taking a short break from working ..... I have been working non stop since 8 am. I am on call for 24 hours today till 8 am tomorrow. Came into work and I had to go into the operating theatre to take over a case of craniotomy .. patient was 38 years old and under the influence of alcohol ... crashed into a truck. He was riding a motorbike. When he was seen in Emergency department, his pupils were already dilated and his GCS ( glascow coma scale ) was 3/15/. His CT Scan of the brain showed midline shift, cerebral odema and subdural haemorrhage. He did not do very well intraoperatively as his blood pressure was lowish and had to be started on intropic support inspite of giving blood and adequate fluids.

Then after this case, I had to continue with a case of Right upper lobectomy for a 56 year chinese male with history of haemoptysis. He was actually planned for an elective lobectomy this coming Thursday.... unfortunately he coughed out about 300 mls of fresh blood and the operation had to be done today. He has a background history of the following... 1) PTB (tuberculosis) in year 2000 which recurred in year 2003 and he completed 9 months of treatment. 2) Bilateral Mycetoma diagnosed in year 2005 (fungal infection of the lungs). 3) Hepatitis C. 4) Diabetes Mellitus 5) Ex- IVDU (drug addict) - stopped 6 years ago. We had to use a double lumen to intubate the tracheal and bronchus so that we can isolate the right and the left lungs. The challenge was having to find a larger intravenous assess for this patient as he has a past history of IVDU.. he has practically used up all his veins and even both femoral veins ( they call it the " highway") for his drug addiction. In the end we had to set a triple lumen on the right internal jugular vein to gain Intravenous assess. Intraoperative .. there was massive blood loss which required blood transfusion and inspite of giving lots of fluids, he had to be started on intropes as his blood pressure was really labile. In the end the surgeon had to remove the whole right lung as it was already damaged by the disease. This case went on from 12 noon to about 7 pm..... we were all exhausted .... sent the patient to ICU for further management ...

Phew .... managed to grab a quick dinner and calm my mind and stretch my legs before I start my other cases ...... just another day in my life as a doctor ...

1 comment:

doc said...

aren't you lucky - you covered 3 major topics for your finals in 1 day - neuro & thoracic anaesthesia, & massive blood trasfusion. now, if only those 3 topics came out in the essays or vivas, you'd be home free!!

all the best!