Skip to main content

ER Diaries : Hepatitis B cover

Serious stuff
Note: Such incidents are a common thing for people from Day 1 of your housejob. You never know what threat you’d be exposed to. Our condition to be honest is worse than soldiers. Soldiers atleast know that they’d die on war . A bomb is expected at the border or a bullet on field. They die an instant death . We are just unaware! Somebody may just knock your door one fine day stating look my mother is really sick , help me out . It’s an emergency. You roll over your sleeves . Manage the case . Only to find the reports stating positivity to viral markers.
Better keep yourself vaccinated to hepatitis B atleast . Hep C and HIV we just can’t help!

 A similar episode happened . An ERPhysician from another hospital walked in to inform us that he was leading an ambulance. A patient is supposed to arrive. He had done CPR on insistence of the family. He was having his meal when the call for help came. He just had to leave everything and go. His resuscitation attempts failed as the patient had collapsed about 20 min back . They got the patient here only for confirmation and he left as he had some work. My senior received the case. Declared him dead. Later they showed  his old files which Said HCV positive. We could say nothing . Do nothing.  You often feel like thrashing the attendants for such oversmart actions.
55 year female brought to ER in unconscious state (E1V1M1) not responding to DPS . Previous history of admission and LAMA from our ER for ?insect bite anaphylaxis ?Diabetic Ketoacidosis .In the same GCS since 2 days. Admitted in a government hospital , administered antibiotics , diuretics and LAMA from there also. K/C/O DM on medication . Urine output about 1 lit per day
On arrival BP 80/60
PR feeble
Saturations 75%
Grbs ( slightly elevated, don’t remember how much) 
Temp : normal

CPR was done without gloves.
O/E
Patient unconscious 
E1v1m1
S1 s2 +
Bae conductive sounds 
Pupils 2mm+
right eye swollen thi function gone 
Nose was red , skin peeled off like that of a burns patient. 
?Mucormycosis suspect kare usko




Rx
Fluid bolus
Hydrocortisone iv
Noradrenaline drip started
Consent taken
Preoxygenation for about 5-10 min
Positioning 
Intubated with
Midaz (sedative) n rocuronium (paralytic) size 7 ETtube
5 point auscultation done
Intubated. 
Saturations improves to 81 later started falling to 60.
Positioning checked again. ET was more on right side . Pulled back . Saturations improved. Connected to brains circuit . 16 breaths / min yaad hai bus.Shifting started . Meanwhile patient had cardiac arrest , adrenaline 2 shots given . Revived . 
CPR started without gloves.
 When you see a patient crash. The adrenaline rush won’t let you think about gloves. All it thinks of is no pulse . Press hard press fast. Let’s get the damn pulse back!
Started on fluconazole dose don’t remember BP around 80-90/60.Shifted to ICU
There it went to 60 systolic . 
Somehow all her investigations were present except for viral markers. Sent . Later got to know she was hbsag positive.
It was first intubation of One of my colleagues , he was happy he did it. When we called him to inform about the status of the patient . There was silence. The doctor who had done the CPR without gloves was disappointed too!

Parallelly   60/m came with c/0 sob grade 3 with orthopnea on n off since 3 days . 
Aw wt loss , generalised weakness, cough c mucoid expectorantion mucoid since 3 weeks. 
Burning sensation in chest on n off
No fever / wt loss / burning micturation / 
Smoker alcoholic . No cad / asthma/epilepsy . NKDA.
LAma from corporate hospital.
They had insurance . I thought they had  come here for the same.

Vitals 
Sats 79% 
Bp 110/70
Pr 110/min
Grbs 112 something 
Temp 98.7
RR 35%
Ecg NSR
Oe
Thin built
Icterus+
Clubbing+
Gcs e4v5m6
Cvs s1 s2 +
* Rs  decreased air entry on R side with b/l wheeze in basal segment

While auscultation he started coughing. I moved away got a mask . Continued examination.
 Missed CNS N PA which I usually do
LE. No pedal edema. 

Looked for reports they got done
CBP Normal
Esr elevated 
HBSAG POSITIVE 
ALP elevated 
Bilirubin Normal limits
CXR right middle lobe opacity 
AFB negative advised repeat sample 
Usg Normal study


Meanwhile they called me for ambu.
I was not wearing gloves . The head nurse insisted that I wear. Wore continued . Baaki sab karke. After intubation replaced OPA . 
Alhamdulillah, mask against one patient helped for another case also. 
Treatment wise 
Connected 4l o2
Nebulisation given Duolin n budecort
InJ hydrocort 200mg is stat
InJ pan zofer
He improved. Chill Baith gayaa . Full active hoke khaana poochna start kardiya.
Spoke to consultant. Bhejdo bole since gEnterologist not available. 😒
Consultants have a choice. ERPs don’t .


So far so much bye!
Labels:

Comments

Post a Comment

Popular posts from this blog

" Consulting a psychiatrist would be a question mark on my spirituality " Said the patient.

Hello everybody  I hope everybody is safe and healthy. it's been a while that I've been receiving lot of patients in the emergency with mental illness ,thought of sharing an incident of its kind. Not sure if its the awareness of mental health these days or the pandemic, I am developing keen interest in patients with mental illness .I try to take an extra effort to make them feel comfortable and try to create an insight of what is happening and offer them options of what all can be done.  Since this it seems like a step towards patient care , I thought I'd share it here as well. This would probably not be the best approach but I welcome any type of constructive criticism , additions or subtraction to my approach because end of the day we are here for best patient care. A 50 years plus old gentleman ,presented to the emergency with the complaints of chest pain radiating to left arm , breathing difficulty, choking sensation in the throat, inability to open his ey
18 comments
Read more

MRCEM OSCE preparation and resources

Hello people Since I have cleared my OSCE in one go, I feel it's my duty to journal what all I have done to make it work.(humble brag).Thanks to ChatGPT for helping me pile up some humble generic sentence to make this blog wholesome.(Just kidding). The MRCEM OSCE exam is an integral part of the qualification which tests the clinical and communication skills of candidates. For Indian students pursuing this qualification, preparing for the MRCEM OSCE exam may seem daunting. However, with a few tips that helped me sail through fine. The thing that helped me the most is acclimatizing myself to the UK Clinical Setting Before appearing for the MRCEM OSCE exam, it is imperative for Indian students to understand the clinical setting in the UK. Sometimes , all they want to see is how you behave , your body language, your tone , and your organising skills. Diagnosis is not a critical thing here. You will not fail if you get a wrong diagnosis provided that you have done it systematically. So
2 comments
Read more

Experience Based Co Design : BCT Series XXIX

  "Experience-Based Co-Design" we have all witnessed its essence unknowingly . My family home is the example I can reflect on .Growing up I didn't like how my house was designed. We (the whole extended family) wanted my dad to sell the house . Dad let his architect friend design our house and would not sell his house (for obvious reasons!). Mum had to balance out the situation so she decided to make small changes. So, it was one change idea each year .She would talk to us individually and listen to our perspective and review her sphere of influence and the impact /utility the idea had.For my siblings the colors were not welcoming while I pointed the flooring. Mum wanted the stairs to be personalised. My grandparents wanted certain conveniences around the toilets. It took her about 4-5 years to make the house a home that was acceptable . From color preferences to spatial arrangements, each family member contributed insights. The lovely thing about it was , the keystakehold
Post a Comment
Read more