Attachment in Alex Part 2

Bismillahirrahmanirrahim

Yesterday marked the end of my attachment in the Emergency Department. Yesterday particularly was quite eventful. There was an accident where a balcony of a building collapsed and fell on to the people below. The victims were badly injured and were brought into the ER of our beloved University Hospital.

The doctor who has been teaching us for the past 2 days was on night shift last night. Remarkably, she didn't looked fatigued when she greeted us yesterday morning. She just commented that last night was a very bad night. So many patients and so many blood she said, gesturing towards her blood spotted coat.

First thing that we did yesterday was, we went to the women's ward. It was more crowded than the day before because of the admissions of new patients from the balcony accident. There was this little girl. She was comatosed but already on artificial respiration.Our doctor gestured us towards the girl in order to see how she insert a central line. Our doctor said she wanted to insert the line into the little girl's internal jugular vein. However, I think she changed her decision and inserted it into the subclavian vein.

Central line

After the insertion of the central line, they give the girl saline fluids through it. After a while, we see blood coming out from the girl's nose. So, the doctors got out the endotracheal tube to suck out the blood. Bear in mind that an endotracheal tube is different from an oropharyngeal tube.

Let's revise our terminology now shall we? Endo means inside. So, endotracheal means inside the trachea. However, oro-pharyngeal means, oro-mouth cavity and pharyngeal-pharynx, so, oropharyngeal tube is placed from the mouth down until the pharynx only.

Endotracheal Tube

Endotracheal intubation

While doing so, suddenly, the girl went into cardiac arrest. Her heart stopped. A senior doctor and several other doctors came to help. They did the CPR and inject adrenaline to try and resuscitate the patient. The girl's mother was in tears, gasping her mouth in fear of losing her daughter. Alhamdulillah, the patient regained sinus rhythm after several cycles of CPR. Afterwards, we went to another bed to observe a doctor suturing a patient's deeply lacerated chin/jaw. The patient fell down the stairs and was yet another victim of the balcony accident. I admire at how neatly the doctor suture the patient's wound. He performed the simple interrupted suture. 

the wound looks sort of like this, only deeper and longer and her cheeks were both swollen.

Then, there was a bit of a commotion. The ward was sort of over crowded and a senior doctor shouted at the visitors to leave the ward. Some visitors/relatives refused to leave and a fight almost broke out but some of them restrained the ones who sort of lost their temper from giving out kicks and punches. Man, it sure is tough being a doctor at a public hospital. Some patients, but mostly their relatives, just have no respect for the doctors when the doctors have really tried to give their best to serve them.

When I thought that I've seen enough drama for a day, we witnessed a death yesterday. A patient was brought in by his son I assumed. The patient looked comatosed but his eyes were open. I interpreted from what the son said, that his father was drinking tea and then he sort of lolling like that. The patient has cancer and was taking morphine. Sarah said he has pin-point pupil but I didn't really noticed that though. As the patient lied down on the bed, the doctors try to assess him. A doctor pinched the nipples, so that the patient would remain conscious. They give the patient oxygen, but then he vomited. It was yellow in colour. They intubate but then, the patient went into cardiac arrest. So, the doctors started to do CPR. By that time, a woman and two men came. I think they were his children. The woman just got a glimpsed at her father and said, "No, no, no, father..." and just instantly burst into tears and one of her brothers or is it her husband, I couldn't really tell had to calm her down and brought her out of the room. The doctors tried to resuscitate the patient but they failed. The ECG reading showed a flat reading which means, the heart's not beating anymore. He's gone, the patient passed away. All the doctors left the room, leaving the patient's children to mourn over him.

Flat ECG

Well, that was it. All I can say is, it's tough being a doctor. 

The worst is yet to come~!

Wassalam.