"saya sebenarnya memang tak sedap hati la pasal makcik sejak makcik mula2 masuk.tapi BUKAN YANG ITU,maksud saya KAKI makcik."
i bet u know already what i meant by BUKAN YANG ITU~~~
to tell you the truth,my heartbeat was nearly TACHYCARDIC..and of course I was feeling nervous.I’ll tell you WHY.
pagi hari khamis haritu (10/3/11),aku nampak makcik dah di PINDAH KE KATIL DEPAN SEKALI and pakai VENTIMASK.
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| VENTIMASK/VENTURI MASK..HEHE...MACAM NAK SAMA NGAN NAMA VOLTURI DALAM CITE TWILIGHT LAK... |
"kenapa makcik ni kak?"
dia cakap,
"makcik tiba2 SOB dari petang tadi.so ni memang dah on ventimask sejak petang tadi."
laaa...ye ke?
sebab masa aku check SPO2 makcik tu pagi semalamnya,still okay lagi.96% on room air.
yelah,kata orang "BILA2 LEH JADI.."
and then,bila aku naik keje petang semalam,jumaat (11/3/11),dah tukar HIGH FLOW MASK 15L/min.HIGH FLOW MASK is a device utk provide oxygen dengan saturasi yang lebih tinggi dari NASAL PRONG iaitu sebanyak 10-15L/min.
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| NASAL PRONG |
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| HIGH FLOW MASK alhamdulilah la,SPO2 pick up 98-99%.sbnrnya,masa senior aku tengah passed over report,aku tengok makcik hampir nak GASPING.sebab tengok the way she breathe,she was using her ACCESSORY MUSCLES.accessory muscles tu ialah scalene, pectoralis major, trapezius, internal intercostals, and abdominal muscles—stabilize the thorax during respiration. Some accessory muscle use normally takes place during such activities as singing, talking, coughing, defecating, and exercising.More pronounced use of these muscles may signal acute respiratory distress, diaphragmatic weakness, or fatigue. It may also result from chronic respiratory disease.  by the time she was wearing the high flow mask,she looked like she's struggling and was trying as best as she could to breathe.if I were in her shoes,I would think of “I AM DYING NOW……Oh Allah,please help me!” |
SEPTIC WORKOUT ialah procedure blood taking atau pengambilan sampel darah untuk mengenalpasti samada terdapat kuman atau tidak.
whereas ABG ialah pengambilan sampel darah daripada arteri untuk mengetahui paras oxygen darah di dalam arteri.
becoz the MO asked me whether houseman (Dr.T) pernah x amik BLOOD C&S patient ni.blood c&s tu ialah satu sample darah untuk kaji samada terdapat kuman atau x dalam darah,especially infected patient.so,i called dr.T who's incharge of this makcik and he said,he have never take any sample for c&s.after that,aku inform la anaest MO tu and dia order soh amik satu sample.
then,anaest MO pun suggest to refer cardio for urgent ECHO.aku tanye dr.T,
"ECHO ni macamana coz her appointment is on june 10th."
so he called cardio MO oncall and he said,
"no need for urgent ECHO due to patient's condition is not suitable for this procedure.so wait until her condition gets better."
"DR.T,ANAEST MO & DR.R DAH PESAN soh u dokumen apa yang u buat."
tapi DR.T said,
"aiyaa,NOT IMPOTRANT LA."
okay la...it's up to u.
apart from that,anaest pun plan utk KIV tapping if patient DYSPNIC.surgeon kita dari pagi,alah...dari story aku haritu pun dah SUGGEST utk pleural tapping.tapi still x de pape perubahan.medical MO pun datang review pagi tu,tapi x de arahan pape pun utk buat tapping.anyway,terpulang.
KIV intubation
if patient's condition deteriorates.masa tu kul 2 petang,medical MO call ward aku and kebetulan,i was the one who picked up the phone.she asked me what did the anaest MO plan for?aku g la amik BHT makcik and bagitau plan anaest.then dia cakap,bagi saya no.telefon dr.T.
so,aku bagilah.x lama pastu,dr.T dtg wad balik pas lunch.dia cakap,
"ain,prepare CVL set k.i nak masukkan CVL."
Aku cakap kat dia,
"doc,tadi medical MO call wad.dia nak no.fon doc.dia ke yang soh insert CVL?"
Dr,T said,
"a'ah"
aku g la prepare set2 sume..and he performed the procedures.attempted x2 successful.pas dah insert tu,he ordered for CXR POST CVL and to do it portabally.form pun da hantar and mamat portable pun datang wad.he said,
"a'ah"
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PROCEDURE KEMASUKAN CVL (CENTRAL VENOUS LINE) |
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| LEPAS TU,JADI MACAM NI...SEBENARNYA KEMASUKAN CVL NI UTK MEMBACA TEKANAN JANTUNG DAN IA ADALAH PETANDA SAMADA PESAKIT MENGHADAPI KELEBIHAN/KEKURANGAN CECAIR DALAM BADAN. ALSO KNOWN AS FLUID OVERLOAD (CECAIR BERLEBIHAN) ATAU DEHYDRATION (CECAIR BERKURANGAN) |
”SHOOTING!!”
sume lari dok blkg mat portable tu sbb dia pkai radioactive protector gown.berat dowh!aku dah pakai masa clinical posting kat OT dulu masa semester 6~yang si dr.T tu g lari masuk dlm pantry...hmmm,habis la sperma ko doc...termusnah la jawab nya..LOL~~~
masa dah insert CVL,dia amik sample blood c&s skali.then baca CVP.first raeding was -3cm/H2O.meaning,makcik dehydrate++.but i don't get it.she already have CCF.overloaded dah sampai edema kaki & tangan.yet,her CVP reading was not good.i wonder why.nanti aku tanye dr.T balik.
Dr.R yang amik sample ABG kul 5 sebab dr.T yang mintak tolong.then bila result balik,aku tanye dia,
”no special order?”.
then he said,
”no.just continue HFM mask la”.
Pastu dia terus balik rumah.
Then,dr.S tanye aku,
”mana R?”
aku cakap dia dah balik.
then dr.S cakap,
”SHIT la!”
Maybe dia nak tau pasal ABG reading makcik kot.sebab R yang amik tadi.
Masa tu pukul 5.30 ptg.CXR of post CVL insertion dah di trace.i showed the film and the ABG reading yang dah amik kul 5 ptg to dr.T.masa tu ada dr.Y and dr.S ada skali.diorang reviewed and dr.S dah wat kesimpulan yang makcik is having DECOMPASATORY RESPIRATION TYPE II.ni la yang aku dengar…based on her PCO2 reading,41mmHg compared to the morning ones,was 35mmHg.
dr.T cakap,
”makcik takkan survive lama…I don’t know maybe malam ni kot….kene jugak intubate…you see,pulse rate dia pun dah 80 something…tadi kan 100 over…makcik pun dah penat…tadi nampak dia cungap2…sekarang dah slow..maybe within 12 hours dia akan…………….i nak inform anaest”
okay,I understood what did he say by …………………….
Don’t you think it’s weird?Weird isn’t it.apsal dr.T cakap sampai nak kena intubate bagai tapi dr.R bagitau no special order?mesti dia just tengok P02 je kot…tapi x perasan PCO2 makcik.
After dr.T cakap macam tu la YANG AKU HAMPIR TACHYCARDIC+NERVOUS!
intubate siot…ingat main2??
Honestly la aku habaq kat hangpa,AKU MEMANG NERVOUS+PANIC bila tau ada patient nak di intubate.especially PATIENT AKU.sebab procedure dia cepat and everything nak STAT.stat means ON TIME.ntah la…memang x leh la nak overcome perasaan macam tu.…aku leh jadi BLUR GILER.TAPI KALAU PATIENT STAFF AKU YANG LAIN,AKU X KISAH.AKU X PANIC.
Dr.R informed DIL (DEATH IN LINE) and explained kat suami makcik kalau makcik x dapat bernafas,kita nak masuk TUBE.then pakcik cakap,kalau itu yang terbaik,buat la.so,he agreed for intubation.Tu masa afternoon rounds kul 3.30 ptg.but then,at 5 pm macam tu,the 2 daughters asked me,
”what was actually the TUBE?”
then I said,
”is it the chest tube that the medical team initially planned for makcik?”
the 1st daughter was unsure of it.aku tanya lagi,
”did u mean by the insertion of chest tube at the ribs”
---I showed her the place at same time.
then she said,
“yang tu akak tau.tapi kenapa x buat lagi eh?bukan hari tu cakap nak buat ke?”
I said,
“memang ada.tapi surgeon kita suggest je.medical ada datang tengok makcik tapi x de arahan utk buat.so kalau x de arahan,kita x leh nak buat.”
Then she said,
“okay,but not that one.”
the 2nd daughter then pointed at her throat.
i said,
“is it the tracheostomy tube yang akak nak tanya?”
she asked me back,
”yang tu macamana eh?”
i said,
”for example in a car accident.if the patient was brought to the hospital and unconscious,then the surgeon in OT will place the tube at his throat untuk beri bantuan pernafasan’
they understood and after that they asked again,
”yang tube lagi satu tu.”
i said,
”yang masuk ikut mulut tu ke?”
they shook their head and said,
”a’ah.”
Aku bagitau,
“ooo yang tu namanya intubation tube.kita intubate patient tu kalau dia dah x boleh bernafas.so dengan intubation,kita masukkan tube dalam mulut dia n terus ke kerongkong.then,kita bagging bagi oxygen untuk supply ke paru2.”
then they said,
”haa,yang tu la…okay2 akak faham.”
then I said,
”tapi bukan ke doctor dah explain kat pakcik?”
Akak tu jawab,
“memang dah explained.tapi agaknya pakcik x faham kot tube tu apa.tapi akak x nak la dik.”
I said,
“kalau pakcik tadi setuju,akak kena bincang betul2 la dengan pakcik.takut kang bercanggah lak pendapat.kalau betul2 x setuju,nanti boleh cakap kat doctor.”
then the 1st daughter said,
”I’ve seen it before in this ward and during my mum was warded in medical ward last time.i saw the doctors did it ………..”
then I said,
”did u mean,the doctors did the procedure roughly?”
Then she said,
”YES.KASAR.so akak x nak la.”
aku pun menambah,
"akak bukan orang medical,so memang akak nampak cara doctor wat procedure tu kasar.tapi sebab saya medical personnel,sebenarnya caranya memang macam tu.let's say family saya masuk wad.kalau saya pun,saya x nak mak saya di intubate.sebab,nyawa masa tu tengah DI CABUT OLEH MALAIKAT.so x nak la menyiksa mak saya lagi nak masuk2 benda tu..”
they agreed with what I’ve said.
pastu,yang 2nd daughter met the doctor (dr.F) who was oncall on that day and she told him the whole family REFUSED FOR INTUBATION,lepas mereka sume bincang.the anaest MO was there,coincidentally.so dr.F directly informed the anaest and the anaest called her specialist.she later wrote down in the BHT : for morphine infusion if patient gasping.so NAR (NO ACTIVE RESUSCITATION) noted.
*panjangnya….macam skrip filem lak*
Selepas beberapa kali CVP reading,thank god the reading was okay la.maintained +5CM/H2O.
Masa aku naik keje malam hari sabtu and ahad (12 till 13/3/11),aku sempat lagi tanye staff yang keje pagi,
”makcik s tu mcmana skrg?”
then staff pagi reply,
”dia dah okay dah.pakai nasal prong je.”
Senior yang sama keje malam dengan aku pun mesej aku gak tengahari tu.tapi masa tu aku x tau lagi makcik s tu dah pakai nasal prong.aku just cerita kdaan dia smlm je.
Bila aku datang keje malam,aku tengok SPO2 makcik pick up.98-99%.makcik pun nmpak tenang and dah x breathing dengan accessory muscles lagi macam haritu.
Pada hari terakhir aku keje malam,aku buka BHT makcik.aku saja nak tengok further plan.pagi n petang tu,MO soh amik ABG.then,tengok PCO2 dia dah decreasing.sikit je pun.haritu ms mula2 pkai HFM,bacaan PCO2 makcik 35 then naik 41mmHg.bila dah pkai nasal prong,PCO2 reading was 35 (pagi),then 38mmHg (petang).even though ada penurunan,tapi makcik memang mmerlukan oxygen supply coz her lung condition is absolutely NOT GOOD.normal PCO2 reading is between 27-35mmHg.more than that range,there must be something wrong in the oxygen-carbon dioxide exchange.as what I had told on my story,previously HER LUNGS COLLAPSED
and HAS FLUID INSIDE IT (pleural effusion)
and HAS FLUID INSIDE IT (pleural effusion)
Selain tu,medical reviewed again.plan medical ialah off IV FRUSEMIDE.continue nasal prong and continue ortho plan.then,ICU reviewed.ICU plan : DISCHARGE ICU.
Haritu masa condition makcik agak teruk mula2,bukan main ek refer anaest (ICU).bila makcik dah x macam tu lg,terus discharge.
Actually the tip of the CVL (2cm) dah terkeluar.bila surgeon tau,dia soh OFF CVL.and before that,mesti dia tengok dulu CVP reading makcik.sebab dah maintain +5cm/H20 so,houseman pun cabut terus.IV Drips pun x yah masuk lagi.
Pada pendapat aku,personally….Makcik ni banyak MEDICAL PROBLEM la selain ortho.…
MO aku pun cakap macam tu.ORTHO satu masalah je pun.bek medical je TAKE OVER.she has had few admissions and still,the SAME OLD MEDICAL STORIES punya cite.aku tak tau la kalau dia discharge ORTHO kali ni (x tau la discharge bila),apa plak masalah dia lagi nanti kalau admit wad.
MO aku pun cakap macam tu.ORTHO satu masalah je pun.bek medical je TAKE OVER.she has had few admissions and still,the SAME OLD MEDICAL STORIES punya cite.aku tak tau la kalau dia discharge ORTHO kali ni (x tau la discharge bila),apa plak masalah dia lagi nanti kalau admit wad.
*KALAU DIA ADMIT WAD AKU LAGI SEKALI,BUKAN sebab AKA STUMP dia yang bermasalah tapi SEBAB MEDICAL PROBLEM,DOCTOR2 YANG CLERK CASE KAT A&E memang nak kena MAKI dengan MO ORTHO kitorang!senang cakap x reti diagnosed ke masalah sebenar makcik….tu je yang aku dok risau.haha….sejujurnya TAK SUKA!*
Sebenarnya,masalah medical yang COMPLICATED nak rawat.ianya dipanggil UNDERLYING PROBLEMS.tapi,kalau dah patient ada masalah sebegitu,nak wat camner.kena la refer patient kat diorang jugak.challenging betul~~~~
Until today,makcik STILL SURVIVE and hopefully she can be discharged home later.
~~ NO MORE ORTHO ADMISSION.IF SHE WERE TO BE RE-ADMITTED,GO TO MEDICAL WARD OKAY!! ~~~
Bukan kami x suka..tapi kami nanti jadi KESIAN kat makcik.
We’ll say,
”APALAH NASIB MAKCIK JADI BEGINI….
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