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Worst Day So Far

Posted Jan 07 2009 6:04pm
THREE deaths in one night. All occuring within 2 hours. Bad eh?

Pt 1: He looked pretty grey, with a low BP. He was not giving us much history. All we knew was he was short of breath and unwell. A chest x-ray revealed a convincing right pleural effusion. The whole of the right lung field was white. A chest drain was then inserted into him. He was tolerating the procedure well, and the chest drain went in pretty easily. Yellowish purulent fluid came out from the drain, which meant that this patient probably has an empyema (pus in his pleural cavity). All of a sudden, as the SHO was stitching the drain in place, the patient's saturation dropped from 93% to 88%, 70%, 60%, 40% ...and undetectable. This heart rate was dropping fast too...until it reached asystole. Fuck! CPR was performed and patient needed to be intubated. However, he did not survive it. It was a very traumatic resuscitation, trust me.

Pt 2: In the receiving unit, patients will be brought up to the ward after having been seen in the A&E first. An elderly lady was wheeled into the ward not too long after the event above. Her family members were asked to wait in the waiting room while the nurses admit the patient. As soon as the elderly lady was taken into one of the rooms in the ward, the nurse who accompanied the patient closed the door and said, "This lady actually died in the lift on the way here." WTF?! Looking further into her notes, the patient had a very low blood sugar level of only 1.9, and guess what? The smarty pants A&E doc gave the patient an IV infusion of normal saline?! What was he/she thinking??? Give 5% dextrose at least....but really you should have treated the patient's low sugar level before bringing her up...maybe a stat 50% dextrose? Imagine the horror of the whole situation!

Pt 3: He had a bad chest infection. His family members were informed that his prognosis would not be good, and they agreed not to resuscitate him, should he goes into a cardiac arrest. The patient was rather agitated towards the last moments of his life. His daughter left the room for only a few minutes to get something, and unfortunately, her father took his last breathe at that time. sigh.

Three different deaths in one night. Hope it doesn't get any worse than this. I was quite traumatized after the first patient. But, I still got to pull myself together to carry on clerking in other patients. Life is tough.
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