Finished morning ward work at 12pm. And wow, phone never stopped ringing ever since :P
12.30pm - 4 new admissions, active HO in charge of clerking patients not yet arrive, busy with work upstairs. Me and colleague settle 3 of the new cases.
1.00pm - Critically ill newly admitted patient needs urgent CT brain. Called radiology department. Both CT scan machines are not working (under maintenance), any emergency cases need to be sent elsewhere for CT scan - in this case a nearby private hospital. Told that houseman need to accompany patient while they arrange for ambulance.
1.15pm - Colleague from upstairs ward passes over list of blood results which need to be traced and informed.
1.30pm - Above-mentioned patient's blood results came back. Severe metabolic acidosis. Hypokalemia 1.47, hypocalcemia 1.88. Loaded with NaHCO3 x5 and fast correction K x2.
1.45pm - Patient intubated due to poor GCS. Developed ventricular fibrillation during intubation. After defibrillation patient asystole, revived by CPR.
2.00pm - Upstairs ward called. Patient with acute coronary syndrome and history of gastritis complained of epigastric pain. Called biochem lab to do serum amylase.
2.20pm - Critically ill patient fitted. Valium given.
2.30pm - Haematology ward called. Patient needs branula for chemotherapy and transfuse platelets.
3.40pm - After long walk to and back from haematology ward, noted above-mentioned critical patient's cardiac monitor shows ventricular tachycardia (VT, nobody even noticed). Ordered for ECG.
3.55pm - Just about to sit down to document about the VT, when suddenly a scream was followed by loud crashing sound. Psychiatric patient was placed beside the window despite strict suicidal caution. So what he decided to do? He heard voices asking him to go die, so he jumped out from his bed towards the window. Restrained by staff nurse but broke several window panes in the process.. IM haloperidol stat for sedation. Psychiatric MO was left shaking her head at us..
4.30pm - Upstairs ward called. Patient's serum amylase came back as >600 (pancreatitis). Need to refer surgical.
5.00pm - Another long walk to haematology ward - 3 patients had fever >38 degrees. Protocol for neutropenic sepsis says triple blood C+S (aerobic, anaerobic, fungal) on both arms before starting antibiotics. So altogether took 14 bottles of blood C+S (used up 28 lab forms, 4 dressing packs, 8 pairs of gloves and 6-8 syringes).
7.30pm - After all the blood C+S, 4 patients need platelet transfusion. Managed to annoy the blood bank MO at a time they are short of blood and platelets, so instead of 4 units, each patient only gets 2.
9.00pm - Another patient rolling about in bed due to excruciating pain. Chest X-ray shows ? suspected air under diaphragm - need to refer surgical to rule out peptic ulcer disease. Attendant has gone out to send blood investigations to the lab, so HO wheeled the patient to X-ray department for repeat CXR.
9.40pm - BUSE/Creat for critically ill patient not repeated since fast correction in the afternoon. Done. K+ still 1.74.
9.50pm - Upstairs ward patient needs accompanying to be transferred to ICU. Asked another colleague to help out.
10.05pm - Patient complained of acute urinary retention due to BPH. Urinary catheter reinserted.
11.30pm - Patient with hepatic encephalopathy fitted. Noted that despite being ordered at 7pm, patient not loaded with antiepileptic coz medication not endorsed on drug chart. Since already ran out of hospital drug charts, resorted to using drug charts imported from Hospital Segamat.
12.00am - End of shift. Critically ill patient died at 12.45am.
