Vomiting Durian...

Durian nowadays is no longer seasonal fruit already.. cos can see durian in the market every few months.. Even nowadays, i can still see durian in the market. Occasionally, seeing those durian will reminds me of something... This event occur 5 years back, in year 2000..

That night, i had a 17 years old malay boy who met with an accident around 4:30 pm in the evening, and half an hour before the accident, he took durian.. ( as i normally will ask the patient when is their last meal and what they took at that time, normally we will only call the case 6 hours after their last meal, since stomach emptying time will take around 6 hours , it's important to prevent aspiration of gastric contents into the lungs which might be a disaster...). The boy suffered compound, comminuted fracture of the femur. I called the case at 10 pm... (6 hours after his last meal). I intubate the patient with cricoid pressure and put the patient under general anaesthesia.

The operation itself took approximately 4 hours and finished around 2 am in the early morning... i reversed the patient from all the anaesthetic drugs and gases that was given to him earlier on... on then... came the 'disaster'... the patient vomited out a large amount of half digested durian (almost one bowl).... and stinks the whole operation theatre... my assistance nurse couldn't stand the 'scene' and she herself went to the sink behind and vomitted out few times... leaving poor me behind cleaning up the mess... sucking the remaining durian debris from the mouth, wiping and cleaning his face... i have to ensure that there's no mores residual vomitus inside the mouth and he is fully conscious before i extubate the endotracheal tube from him.... (Normally stomach emptying time will takes around 4 to 6 hours but the process may be impaired by certain factors, such as major trauma events like accidents which might cause gastric stasis.... which was well proven in this case, as the food particles still stay intact in the stomach even though 10 hours had passed....)

Luckily there's no more emergency cases after that, or else it's really torturing to stay in the "contaminated" operation theatre.. The partially digested durian really stinks.. and the smell remains there inside the fully air conditioned operation theatre for quite some time :(

Actually, i have encountered several episodes of vomiting patients just before they wake up from anaesthesia on the operation table...

in fact, i did encounter with few more disgusting episodes whereby the patients vomit on my clothes when i reverse them from the anaesthetic drugs and volatile agents as i am standing beside their head, sucking the salive from their mouth, and .... if that is not your day, then i'll get all those greenish/yellowish vomitus vomiting out ... and the worse thing is that you cannot go out to clean yourself or change your cloth immediately but have to attend to the patient first, or else they might aspirate their own vomitus or fell down from the operation table... (some will struggle in the merge of waking up), if unlucky, will even hit by them if unaware or not careful... what a job!!!!