Wednesday, April 15, 2009

When the Heart Fails..



" Come down to resus now!" Dr Irina ordered

Oh no..Resus room?i've never been there before.
Resus room is in the emergency department, whereby all the unstable patient is placed and being resuscitated.

I quickly ran to the lift and frantically pushed the button to the 2nd floor.

Within few minutes, i had arrived at the Emergency department.(ED)

ED is a haphazard place to say the least. There are number of patients of all disciplines awaiting further management.

There is a sense of adrenaline rush entering ED, pumping through the vein.

....
" Sorry..mm.. I'm from ortho dept..where's the resus room" I asked with my eyes searching the room.

" Resus..I just came from that room just now..go straight and then to your left" The Dr in charge of ED assisted.

"thanks..i've never been there before' i grinned, thanking her and quickly found my way..

...........
" Azhani, room 4"..Called out by a familiar voice. Dr Irina.

"coming.."..I reached the room and there stood a number a staff attending to what seemed to be a young gentleman, strapped onto a bed.

I froze..The upper arm of the young man, was cut off..It was hanging by a thread, I suppose..Bleeding was profuse. He was on blood transfusion.

Everyone was looking at me, since i had just arrived. There was a specialist from hand and microsurgery department , several medical assistnt and my medical officer. They were struggling to stop the bleeding.

I didn't know what to do at the time. I tried to stand as near to the patient and to see what was the other problems that he might have sustained.

I reached for the glove and tried to get ahold of the other limb.

" Azhani, you take the Full blood count, coagulatoin screen, renal profile and crossmatch. We need another 6 pints for this patient"

I nodded and grappled the needle, syringe and cotton swab.

The rest of the staff left me after they had bandaged the wound.

"Kak..i'm so thirsty..just get me some water..please"..the gentleman pleaded.

" I'm sorry..but you can't. we're going to have an opeartion soon. You have to be fasted".. I struggled to get the vein. I tourniqued the right upper arm and managed to get the brachial artery. Alhamdulillah, it was easy and I quickly filled in all the test tubes.

.................

" Azhani, make sure that the bloods are ready stat,okay. He's bleeding terribly.."

"okay..i'll call the blood bank "

"Hello, this is dr azhani from orthopedics.. I have ordered 6 pints for this patinet...and need it stat . He's profusely bleeding and his vital signs are deteriorating"..

-------------------
I dashed back to ED, and trying to find the PPK to send the bloods. Unfortunately, the PPK could not be seen.

I ran to the blood bank myself and ordered the staff to prepare the bloods as soon as possible. I went back to Resus room and met up with the patient's family members.

" Doctor, how is he?" the father asked with pure agony

" Currently, he has lost massive amount of blood, but it should be okay. He's still a young person. We're trying our best, but if the bleeding still persist, then his condition could still deteriorate." I explained." But what happened ? How did he get this injury?"

They explained that the son was involvedin a fight and he was attacked using a parang. The offender had hit him on the head and subsequently tried to chop off the limb with parang.

I shuddered at the story ..
Astaghfirullah..how can a person be so callous as to do such a thing? I thought to myself. How can a person's heart be so hard?
" Then , after that, your hearts were hardened and became as stones or even worse in hardness. And indeed, there are some stones out of which rivers gush forth , and indeed, there are of them ( stones) which split asunder so that water flows from them, and indeed, there are of them ( stones) which fall down for fear of Allah. And Allah is not unaware of what you do". (Al - Baqarah: 74)
----------------------------
" Go call your MO now! " all of a sudden, a voice from room 4 called out.
I went to the room and found that the gentleman was unarousable.

Pulse rate was dropping. 64 beat per minute. blood pressure was dipping. Oxygen saturation was down to 38 %.

Astaghfirullah..what has happened?

" Tell your MO to talk to the patient's family. I dont know whether he's going to make it. We're going to intubate him." the ED MO voiced out.

" Dr Irina, the patient is deteriorating, vital signs are unstable" I cracked out.
---------------------
Within minutes of arrival, the patient was already attended by numerous staff. CPR was performed as the patient was going asystole.

30 minutes of resuscitation had failed to revive him.

pupils already dilated and he was soon pronounced dead.
To Allah We Will Return..
-------------------

Indeed, if a person do not realize that he will be returned in the land of Akhirah..and he does not realize that he is only a mere slave in this world..he will be able to do whatever he wishes in this world. His action will be acted upon his desires.
Nay! verily, man does transgress( in disbelief and evil deed). Because he considers himself self - sufficient ( Al - 'ALAQ:3)

Due to the feeling of pride, man tend to have the feeling of supremacy above others. He does not fear the day of the Ressurection. He does not fear his creator. He then dare to go beyond the limits that Allah has set upon mankind
, even to the extend of taking the life of another human being.

The He showed him what is wrong for him and what is right for him ( As-Shams:8)

------------------------------------
What is CPR?

Cardiopulmonary resuscitation (CPR) is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest.[1] CPR is performed in hospitals, or in the community by laypersons or by emergency response professionals.[2]

For 50 years CPR has consisted of the combination of artificial blood circulation with artificial respiration[1] i.e., chest compressions and lung ventilation.[3] However, in March 2008 the American Heart Association and the European Resuscitation Council, in a reversal of policy, endorsed the effectiveness of chest compressions alone--without artificial respiration--for adult victims who collapse suddenly in cardiac arrest (see Cardiocerebral Resuscitation below).[4][5] CPR is generally continued, usually in the presence of advanced life support (such as from a medical team or paramedics), until the patient regains a heart beat (called "return of spontaneous circulation" or "ROSC") or is declared dead.

CPR is unlikely to restart the heart, but rather its purpose is to maintain a flow of oxygenated blood to the brain and the heart, thereby delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage.

WHat to do ?

In short, the procedure for "hands-only" CPR is simple. An untrained bystander who sees an adult suddenly collapse (after verifying that the person is unresponsive and is not breathing) should do just two things:

1) Call 911 (or send someone else to do this if you are not alone), and if others are present, send someone to find an AED (automated external defibrillator).

and

2) Push hard and fast in the center of the chest. The rate should be fast, about 100 presses per minute, but it's not necessary to count. Just initiate deep, rapid, continuous presses on the center of the chest and continue until the victim awakens, an AED is found, or emergency personnel arrive.

Hands-only CPR eliminates the mouth-to-mouth breathing of conventional CPR (alternating 30 chest presses and two quick breaths). Although hands-only CPR is very effective, it is not as beneficial as conventional CPR in a patient who is not breathing.

In all children, and in adults who collapse after a near-drowning, drug overdose, or carbon monoxide poisoning, mouth-to-mouth breathing should still be included to get air into the lungs.

Studies have shown that hands-only CPR can be as effective as conventional CPR and may save lives. Those who have been trained in conventional CPR may still opt to use conventional CPR instead of the hands-only technique.


***NOTE: This reference is only intended to serve as a guideline for learning about CPR. It is not intended to be a replacement for a formal CPR course.

( if any of you have the chance to undergo CPR course, it is very useful to do so)

references:
http://www.emedicinehealth.com/cardiopulmonary_resuscitation_cpr/article_em.htm


2 comments:

shahadah said...

ur story's very touchable. that how exactly u work in all day? mulia nya kerja akak. and the most honour when a heart can feel Allah in her life in whatever she does. may Allah owez give u strength to be Islamic Dr.

we should remind ourselves that we'll return to Allah. and make prepare for the Day of Judgement. thnx for sharing this story.

Azhani said...

tapi kitorang tak delah everyday have an acute case..but it's quite common that patients can become unstable