Assalammualaikum.
-warning: Entry ni banyak jargons. Maybe susah for non-medical persons to understand-
Starting this year, we MOs are divided into pools ie OT pool and ICU pool.
Everyone will remain in the pool for the whole month and then we either rotate or stay in the pool, depending on our boss.
I was in OT pool in Sept, then Oct in ICU pool - which explains why I had so many thoughts on critically ill patients in mind.
I am now in OT pool until next January - that is 3 months yeayy.
2nd Nov was my first OT call after switching pool. Dah lama x buat spinal wey.
But thankfully I had L, a floating MO to tag with me for 24 hours.
He does most of the work, I was there mostly to supervise and decide some minor things.
And he had two failed spinals that day. No, this entry is not tobitch about him, it is just for me to read back in the future about some of my cases I experience during oncalls.
Caesar yg kena convert GA
First case yg failed spinal tu was for EMLSCS for an unstable lie in labour.
O&G post kt L - G2P1 unstable lie, os 2cm, contractions 1:10mins tapi last meal belum cukup.
Ada lagi sejam lebih before the fasting time (6 hours) complete untuk patient tu. For those who don't know, patient nak op akan kena puasa at least 6 jam.
Lagi lagi klo patient pregnant sebab nanti ada risiko tinggi untuk tersedak makanan, masuk paru2 and mati - senang cerita. Igt suka2 doktor nk suruh patient jangan makan?
That time I was doing appendix case, and ada lagi 2 appendix menanti..
And since surgical team dah ada dalam OR, and salah satu appendicitis tu in sepsis, TWC 26 - I called that one first.
So I rush the current surgeon untuk habiskan appendix tu cecepat.
Aleh2 dia bagi HO dia close the skin, I said "Okay tapi klo HO u lambat sgt, u hv to take over sbb I hv EMLSCS"
Obviously HO dia lambat la, tapi dapat la jgk stitch more than half of the wound.
Sekali patient ni pulak lambat banguuuun. 15 mins post reversal, the kid still hasnt emerge from anaesthesia - lalok lagi adik tu, x boleh extubate.
Last2 lambat jugak induce appendix yg sepsis tu.
I was already fidgety that time, kang tiba2 O&G post unstable lie tu as fetal distress, dah kena bukak second OT. Kan susah.
And I texted Farahin tnya - kenapa os baru 2cm and contractions 1:10 dah kira in labour?
And betul la apa Frhn ckp; os dah bukak, and dh ada contractions, in labour la tu.
I got confused between in labour and active phase of labour.
Seb baik tnya Frhn dlu, sbb klo tertanya O&G sini, maluuu.
Kena pulak appendix yg sepsis ni complicated, Masz x dpt nak release tip of appendix hence Mr I scrub in and korek keluar appendix nye.
At least mencepatkan lah, boleh la pggl caesar tu cecepat.
Pastu tengah2 L membagi spinal, tiba2 ada aspirate blood pulak.
In the middle of administering spinal drugs, usually we aspirate sikit nak tengok the CSF again. And we usually can see the "cloud" coming into the syringe - ie the CSF lah.
Tp yg L pnya ni, aspirate keluar blood la pulaaak. So ktorg betul2 kan, position balik etc, dpt balik CSF nye.
Tp by then dh mendak kot ubat spinal yg lain hence the block jadi patchy. Patient still sakit bila surgeon testing kt perut 😣
So terpaksa la call Boss John - discuss next step.
Boss kata GA je lah. Uhhhukss. Utk yg tak tahu, men-GA-kan perempuan mengandung adalah sesuatu yg seboleh2nye MO Anaest nak avoid.
Bahaya wey, banyak risiko nye. Paling menakutkan, klo hypoxic smpai mak tu brain damage. Kau nk jawab kt court?
Nasib baik tadi tggu utk last meal dia habis and siap ter lambat sejam lagi sbb buat appendix dlu.
Baby nurse terus call Paeds utk standby sbb mummy under GA kan.
And intubate la itu mummy - uneventful. Op pun uneventful.
Baby je lalok. Mula2 keluar menangis pastu lalok pastu kena PPV. Last2 admit NICU under CPAP for TTN 😞
Indian yg Failed Spinal
Ini memang nk ketok L.
Bunyi mcm rasis, but no. Not rasis. Patient ni memang India mari, barely speak Malay or English hence everything was translated by the Indian employer.
Nak debride wound di kaki nya, so L bagi la spinal.
Spinal tu nampak mcm smooth je - I wasn't really paying attention sbb by then mcm dh trust L, and I started documenting BP HR sume.
Nak test level pun susah sebab the patient mmg tak faham ktorg ckp. So suruh surgeon proceed je drape.
Sekali waktu surgeon test pkai forceps, meringkuk2 patient tu sakit. Alahai kesian.
Tapi kaki sebelah dah berat, cuma yg op side je still sakit and x berat sangat. Tilt tilt table, tunggu 15 mins pun sakit lagi.
Wktu tu dah 2 lebih pagi, mata dah berat - kes x habis lagi.
Nk convert GA alaaaaahai.
Last2 supplement Ketamine. Yeay wonder drug mmg do wonders.
Terus patient lalok and tak sakit. Tnya sakit ke (secara body language) - dia kata tak, sambil mata dia dh membesar dan bercahaya kerana Ketamine. Heee~
Terasa berjaya sangat.
Tapi bila dah kena supplement2 Ketamine ni, tak boleh la nak tinggal kan L utk jaga OT sesorg.
Patient sakit je which is about every 20mins, kena tambah 10mg Ketamine and so on.
And akhirnya berjaya habis op, tanpa perlu convert GA.
Alhamdulillah.
Ok habis sudah ceritera oncall.
Till next time :)
-Because life is a test-
-AkMaR-
http://nur-akmar.blogspot.com
-warning: Entry ni banyak jargons. Maybe susah for non-medical persons to understand-
Starting this year, we MOs are divided into pools ie OT pool and ICU pool.
Everyone will remain in the pool for the whole month and then we either rotate or stay in the pool, depending on our boss.
I was in OT pool in Sept, then Oct in ICU pool - which explains why I had so many thoughts on critically ill patients in mind.
I am now in OT pool until next January - that is 3 months yeayy.
2nd Nov was my first OT call after switching pool. Dah lama x buat spinal wey.
But thankfully I had L, a floating MO to tag with me for 24 hours.
He does most of the work, I was there mostly to supervise and decide some minor things.
And he had two failed spinals that day. No, this entry is not to
Caesar yg kena convert GA
First case yg failed spinal tu was for EMLSCS for an unstable lie in labour.
O&G post kt L - G2P1 unstable lie, os 2cm, contractions 1:10mins tapi last meal belum cukup.
Ada lagi sejam lebih before the fasting time (6 hours) complete untuk patient tu. For those who don't know, patient nak op akan kena puasa at least 6 jam.
Lagi lagi klo patient pregnant sebab nanti ada risiko tinggi untuk tersedak makanan, masuk paru2 and mati - senang cerita. Igt suka2 doktor nk suruh patient jangan makan?
That time I was doing appendix case, and ada lagi 2 appendix menanti..
And since surgical team dah ada dalam OR, and salah satu appendicitis tu in sepsis, TWC 26 - I called that one first.
So I rush the current surgeon untuk habiskan appendix tu cecepat.
Aleh2 dia bagi HO dia close the skin, I said "Okay tapi klo HO u lambat sgt, u hv to take over sbb I hv EMLSCS"
Obviously HO dia lambat la, tapi dapat la jgk stitch more than half of the wound.
Sekali patient ni pulak lambat banguuuun. 15 mins post reversal, the kid still hasnt emerge from anaesthesia - lalok lagi adik tu, x boleh extubate.
Last2 lambat jugak induce appendix yg sepsis tu.
I was already fidgety that time, kang tiba2 O&G post unstable lie tu as fetal distress, dah kena bukak second OT. Kan susah.
And I texted Farahin tnya - kenapa os baru 2cm and contractions 1:10 dah kira in labour?
And betul la apa Frhn ckp; os dah bukak, and dh ada contractions, in labour la tu.
I got confused between in labour and active phase of labour.
Seb baik tnya Frhn dlu, sbb klo tertanya O&G sini, maluuu.
Kena pulak appendix yg sepsis ni complicated, Masz x dpt nak release tip of appendix hence Mr I scrub in and korek keluar appendix nye.
At least mencepatkan lah, boleh la pggl caesar tu cecepat.
Pastu tengah2 L membagi spinal, tiba2 ada aspirate blood pulak.
In the middle of administering spinal drugs, usually we aspirate sikit nak tengok the CSF again. And we usually can see the "cloud" coming into the syringe - ie the CSF lah.
Tp yg L pnya ni, aspirate keluar blood la pulaaak. So ktorg betul2 kan, position balik etc, dpt balik CSF nye.
Tp by then dh mendak kot ubat spinal yg lain hence the block jadi patchy. Patient still sakit bila surgeon testing kt perut 😣
So terpaksa la call Boss John - discuss next step.
Boss kata GA je lah. Uhhhukss. Utk yg tak tahu, men-GA-kan perempuan mengandung adalah sesuatu yg seboleh2nye MO Anaest nak avoid.
Bahaya wey, banyak risiko nye. Paling menakutkan, klo hypoxic smpai mak tu brain damage. Kau nk jawab kt court?
Nasib baik tadi tggu utk last meal dia habis and siap ter lambat sejam lagi sbb buat appendix dlu.
Baby nurse terus call Paeds utk standby sbb mummy under GA kan.
And intubate la itu mummy - uneventful. Op pun uneventful.
Baby je lalok. Mula2 keluar menangis pastu lalok pastu kena PPV. Last2 admit NICU under CPAP for TTN 😞
Indian yg Failed Spinal
Ini memang nk ketok L.
Bunyi mcm rasis, but no. Not rasis. Patient ni memang India mari, barely speak Malay or English hence everything was translated by the Indian employer.
Nak debride wound di kaki nya, so L bagi la spinal.
Spinal tu nampak mcm smooth je - I wasn't really paying attention sbb by then mcm dh trust L, and I started documenting BP HR sume.
Nak test level pun susah sebab the patient mmg tak faham ktorg ckp. So suruh surgeon proceed je drape.
Sekali waktu surgeon test pkai forceps, meringkuk2 patient tu sakit. Alahai kesian.
Tapi kaki sebelah dah berat, cuma yg op side je still sakit and x berat sangat. Tilt tilt table, tunggu 15 mins pun sakit lagi.
Wktu tu dah 2 lebih pagi, mata dah berat - kes x habis lagi.
Nk convert GA alaaaaahai.
Last2 supplement Ketamine. Yeay wonder drug mmg do wonders.
Terus patient lalok and tak sakit. Tnya sakit ke (secara body language) - dia kata tak, sambil mata dia dh membesar dan bercahaya kerana Ketamine. Heee~
Terasa berjaya sangat.
Tapi bila dah kena supplement2 Ketamine ni, tak boleh la nak tinggal kan L utk jaga OT sesorg.
Patient sakit je which is about every 20mins, kena tambah 10mg Ketamine and so on.
And akhirnya berjaya habis op, tanpa perlu convert GA.
Alhamdulillah.
Ok habis sudah ceritera oncall.
Till next time :)
-Because life is a test-
-AkMaR-
http://nur-akmar.blogspot.com
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