There are about more a dozens of AEDs in Hong Kong, What is so special about the one I work in?
It is the only one that patients are not admitted to the wards and jams up in the my department when the wards are full.
However, there are something that my AED is first (according to my boss)
1) 1st AED in Hong Kong having bedside Tropinin level test
2) 1st AED in Hong Kong giving thrombolytics + Enoxaparins
3) 1st AED in Hong Kong having a chest pain protocol
4) 1st AED in Hong Kong having Emergency Nurse Practitioners
5) 1st AED in Hong Kong being a real trauma centre with a dedicated trauma team
6) 1st AED in hong Kong giving Isoket infusion
星期日, 5月 25, 2008
星期日, 2月 10, 2008
Feeling weird
Tonight, I saw a man with massive blood vomiting. He was still alert when transferred from NDH. He recognised me, and then I recognised him. I met him in ICU when he was admitted fro Type A Aortic dissection, had it stented, then developed quite a few complications before he was discharged, he was in bed 8, quite young (in the 40s) and had incredibily difficult arterial lines.
He vomited 3 more pints of blood in the trauma room, BP plummeted. 2 pint of unmatched blood was infusing into him at the same time. It was very scary. I tried super hard to put in an arterial line before he went in for CT, and needed 5 or 6 tries before I finally put on in. The surgeon decided to go for OGD instead of CT because the scanner is not ready for another 5 minutes. He was sent to the endoscopy centre, and then he died.
I talked to the surgeon (consultant vascular surgeon) afterward, he said he has an aorto-oesophageal fistula. Because of his aortic stent that was put in for his dissection, there is no way for the surgeons the control the proximal aorta during the operation and hence surgery cannot save him. The surgeon thought there is no one in my hospital that can save him.
I had funny feeling, maybe it is because I did not think I would see an aorto-enteric fistula in my life, or maybe because I have known the patient for quite sometime and he suddenly died, or maybe because I felt that all my hard work in the ICU and trauma room saving the man has been in vain.
He vomited 3 more pints of blood in the trauma room, BP plummeted. 2 pint of unmatched blood was infusing into him at the same time. It was very scary. I tried super hard to put in an arterial line before he went in for CT, and needed 5 or 6 tries before I finally put on in. The surgeon decided to go for OGD instead of CT because the scanner is not ready for another 5 minutes. He was sent to the endoscopy centre, and then he died.
I talked to the surgeon (consultant vascular surgeon) afterward, he said he has an aorto-oesophageal fistula. Because of his aortic stent that was put in for his dissection, there is no way for the surgeons the control the proximal aorta during the operation and hence surgery cannot save him. The surgeon thought there is no one in my hospital that can save him.
I had funny feeling, maybe it is because I did not think I would see an aorto-enteric fistula in my life, or maybe because I have known the patient for quite sometime and he suddenly died, or maybe because I felt that all my hard work in the ICU and trauma room saving the man has been in vain.
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