Monday, September 12, 2005

On call in Maternity Hospital

On call in Maternity Hospital yesterday. Early in the morning, before my on call started.. I received a call on my handphone while I was driving on my way to hospital.. The phone call was from my colleague who was on call the day before... Telling me to go to General Hospital straight, cause there is a case of Bleeding Placenta Praevia Major Type 3 Anterior, which will be done in GHOT. Mmmm... This doesn't sounds good. What a day to start with... Normally we prefer to do bleeding cases in GHOT(provided the patient is stable enough to be transfer over in the ambulance) cos in emergency bleeding cases, can get the blood products faster.. since the blood bank is over here.. and there are more staffs to help out as well if there is an red alert..) In MHOT, I am basically doing the "one-man show" cos I'm alone by myself.. and my GA nurse or assistant in MHOT is very very junior..

The patient hasn't arrive yet when I reached the hospital... Well, it's expected cos it takes time for the arrangement of ambulance & transferring the patient...I get my pager from my colleague before going up to the operating theatre. (I hate carrying pager... To me, pager is indeed a very annoying thing.. Hate the beeping sound.. I really prefer my colleagues to call me straight on my handphone...)

Regarding the case, this is her 3rd episodes of PV bleeding.. She was hospitalised for more than a month already. G3P2 at 36 weeks plus. (She was earlier on scheduled for elective LSCS next week). Her haemodynamic was stable but with only one green 18G branula :(. There's 6 pint blood in reserve. I set another two big bore branulas for her before starting the case. One good thing is that she doesn't has any previous scar.. The LSCS was done under General Anaesthesia. Rapid sequence induction with cricoid pressure. Cormack & Lehane 1. The Caesarean Section went smoothly without any complications. Blood loss around 500 ml. I have done quite a number of bleeding placenta praevia major cases previously and most of these cases are straight forward cases, but there are few cases which need to proceed to hysterectomy cos of placenta accreta, uterine atony.. etc etc with uncontrollable bleeding..

Have few more Caesarean Section cases later on in the day, but those are "minor" cases, all done under spinal anaesthesia.. One of the cases (fetal distress).. the patient is really "fantastic"... She can fall asleep to the extend of snoring, while the caeserean section is in progress... And I didn't give her any sedations or any sedative drugs at all!! Better still ... when the nurse bring in the baby to show her (We attempted to "wake" her up by calling her name, and shaking her shoulder... but somehow she is too "sleepy" and unarousable.. hahhaha) So we abandoned the idea of showing her the newborn baby :) She continued sleeping and snoring till the end of the surgery. She was still quite sleepy when we wake her up at the end of the surgery... Some people can really sleep very well, huh?!

6 comments:

sLenZieLiECioUs said...

heard spinal anaesthesia very painful eh...

Chen said...

slenz,

u mean painful during the spinal needle insertion or during the surgery?

It's "operator" dependent as well.. Cos giving spinal anesthesia needs "skill". If the person who perform spinal anesthesia is not good with the procedure.. then he/she might have difficulties to get the correct space :) But prior to the spinal needle insertion, we give give LA or local anaesthetics... Shouldn't be painful, unless there's multiple attempts...

However, if the patients who is going to receive the spinal anaesthesia is obese or have spine problem like scoliosis or calcified interspinous space.. there might be difficulties to locate the space as well :)

After the spinal anaesthesia, the limbs will be numb & heavy.. So they won't feel any pain during the surgery.. although the sensation to touch is still there, but it's painless..

babe_kl said...

spinal anaesthesia = epidural?

wahliau can sleep thru birth?? must hv been her no 6th kid eh? :p hehehe

Chen said...

BabeKL,

spinal anaesthesia is different from epidural anaesthesia... but both are regional anaesthesia. We inject the drugs(local anaesthetics) to different space..

For spinal anaesthesia, the drugs is given in the subarachnoid space; but for epidural anesthesia, the drugs is injected into the epidural or extradural space.

Different needles are used.. The needle for spinal is much smaller than the needle for epidural :)

btw, that's her 1st babylah... hahaha
unbelievable leh? :P

babe_kl said...

thanks for explanation

wahliau like dat oso can one? i wonder wat kind of mummy she will turn up to be

Chen said...

BabeKL,
for sure she won't have sleepless night loh.. Cos she won't be easily disturbed by the baby crying sound :D