Wednesday, March 19, 2014

Right man at the right place on the right time

Omg. Adrenaline rush. Im really thankful for what happened last night.

Has been a while since i've been in the ward. Was in the operation room and clinic for the whole week. Tired fun and interesting, that all i can say. 

So yestersay back into ward on night shift and taking care the whole ward alone in ward 14 (1st class surgical ward) all new pts, new cases, unfamiliar faces.

Good thing in 1st class ward is, all patients are stable. They wouldn't allow pt even with nasal prong oxygen to be in first class ward because pts stay in the room, not in the cubicle like general ward where staff can observe closely pt all the time. First class ward they hv more privacy where staff only attend pt if needed.

So routinely, taking pass over, know every pts in out, round with specialist twice on night (once with kkm team, once with vascular team) and do night review for all pts.

Done round with both specialist at 7pm and i did another round at 11pm, alhamdulillah all pts are stable. Some minor issues staff nurse inform dxt, bp, new transfer in, post op rv, cancel op, yada yada...

There is one pt, S. I recognized him as i was assisting in his op on the day before for total thyroidectomy. I made a mistake, little strong retraction on the muscle causing neuropraxia to the nearby nerve. My boss already told me yesterday; i better check on pt post op as pt may developed horseness of voice, and that will be my mistake. *gasp.

I checked on him today, he has it. I feel bad. (seriously i really feel bad, told my colleague and he said, things happened,  thats why we have consent.) im not sure if it is supposed made me feel good or glad despite of the mistake ive done, or what. But S said his voice getting better, slight relieved, and i just hope it is temporarily and will resolve soon. I apologize, but not telling him it was my mistake. Just you know, things happened, and its common complication. And i still feel bad.

Almost midnight, staff nurse inform me pt's wife call and tell S is feeling uncomfortable.
You know in first class ward, sometimes they can be annoying and bugging you for small issues, that you still hv to attend and entertain.

Attend pt stat. He complain of uncomfortable at left shoulder and pain at the op site. I think that are common but... He describes the pain as strangulate pain and having difficulty in breathing. he's tacypneic, check on lungs clear, palpate on the neck, i couldn't find any difference. Noted slight oozing of blood from drain on the left neck. He's on pcm and tramal. So Im thinking to give him oxygen and escalate the analgesic for him.

The thing in surgery is, everything you do, you hv to inform your MO. Called my boss; drO and thankfully he's coming stat (which is rare). He said to transfer pt to acute cubicle active general ward for close observation. Out of nowhere suddenly my specialist; msS come. And she said, called anaesth need push pt to OT now and prepare suture kit on the bedside. 

Omg. Omg.

Yeah he has post op bleeding. It is a close space, causing compression. I didnt thinking about it and didn't see that. (yeah, eyes cannot see what mind doesnt know) It's all so sudden, i check on him an hour ago, he is fine. He talks to me and walking around in the ward. Further history from his wife, she claims pt cough and try to expel sputum before incidence happen. And maybe one of the clip on artery dislodge.

While im calling anaest, drO and msS open the incision bedside to release the pressure, and there is a lot! of hematoma and bleeding. Pt's blood is o neg. Calling MO PDN for blood and call for help from colleague from passive ward. They came and help run for blood to PDN while other ho standby awaiting in OT.

i dont know where MsS come from but she said once she heard drO wants to transfer pt to acute cubicle, thts not right. Her first pt with neck hematoma passed away because of hypoxia. They transfer that patient to acute, gave high flow mask and even refer to anaesth and pt intubated. But it was late already. 

Im really thankful. for drO come stat see the pt, msS coming out of nowhere and save the pt's life, and colleague from passive ward even come to help me; thank you.

So mistake learned.

Next time u see pt post op thyroid surgery with that kind of features, pls send pt back to op immediately. another minute late, patient may have die.