Wednesday, May 6, 2009

rounds at ICU

Currently i'm in charge of periphery - for Orthopaedics. Thus, my team, which consists of 2 medical officers and 2 other houseman would be the ones to receive referrals from other departments and whenever we are together managing a patient.

Last week and the beginning of this week, there were lot of ICU patients that we have to look upon. Before this, I was not that accustomed to being in the ICU that much. But since last week, we have had to visit the ICU everyday.

ICU stands for intensive Care Unit. This is where all the unstable patients are being managed. Being in the ICU is quite a daunting experience. All the patients there are intubated. The glasgow comma scale being less than 4 and all.

One of the patients that we had planned for instrumentation had passed away 2 days ago. The reason being was severe head injury. She had an alleged Motor vehicle accident. She was a pillon rider on the motorbike. The sad part is that she was only 20 years old.

When they did the brainstem test for the patient, it was positive. It was not surprising that much, since earlier it was already noted that the eyes were dilated and fixed. She also had concurrent problem, implicated with Diabetes Insipidus.

Another patient of mine was a gentleman, of 23 years of age. He was involved in an accident whereby he was riding a large motorbike, a Kawasaki.

The family was from a wealthy one, nonetheless.

Being in the ICU means that you are dealing with patient with poor prognosis. Most of them in comatose c ondition, and many of them may not make it through. Thus, you are surrounded with endless tears from the family members.

I had to get the consent from the family members with regards to proceed with the operation. Almost all of the consented and understand the condition. However, in reality, if you push aside the aspect of work and all, these are human beings, at the peak of their emotions and suffering.

I do not know whether we are all relating to the actual event.

Hospital is a place where there is not much happiness that surrounds it. People come to the hospital in the state of weakness and in need of help. Currently, i have worked 2 months nonstop since i have joined orthopaedics. Day in, day out, night and day..i'm just being cooped in the hospital. InsyaAllah this weekend will be my first weekend off if I'm allowed to. Sometimes, working without rest can do a lot of disaster to your state of being. The spiritual and emotional aspect of the workers would get easily affected.

what i learned most since recently is that it is important that each one of us really take care of what we are being entrusted upon. This means our deen, our life, our family's life and all..

Once we have reached our end, nothing is able to help us , no one can prolong someone's life, even for 1 secodnd, when Allah has decided that our time has come.

We have to ensure that we lead a life that Allah would redha us and doa for a good end..Amin..


Terms :


Endotracheal intubation is the placement of a tube into the trachea (windpipe) in order to maintain an open airway in patients who are unconscious or unable to breathe on their own

Glasgow Comma Scale:

Glasgow Coma Scale or GCS, sometimes also known as the Glasgow Coma Score is a neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale).
GCS was initially used to assess level of consciousness after head injury, and the scale is now used by first aid, EMS and doctors as being applicable to all acute medical and trauma patients. In hospital it is also used in chronic patient monitoring, in for instance, intensive care.

The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).

Best eye response (E)
There are 4 grades starting with the most severe:
No eye opening
Eye opening in response to pain. (Patient responds to pressure on the patient’s fingernail bed; if this does not elicit a response, supraorbital and sternal pressure or rub may be used.)
Eye opening to speech. (Not to be confused with an awaking of a sleeping person; such patients receive a score of 4, not 3.)
Eyes opening spontaneously

Best verbal response (V)
There are 5 grades starting with the most severe:
No verbal response
Incomprehensible sounds. (Moaning but no words.)
Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange)
Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)

Best motor response (M)
There are 6 grades starting with the most severe:
No motor response
Extension to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, extension of wrist, decerebrate response)
Abnormal flexion to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response)
Flexion/Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls part of body away when nailbed pinched)
Localizes to pain. (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.)
Obeys commands. (The patient does simple things as asked.)

1 comment:

Anonymous said...

i think you misspelt pillion dear aning