Tuesday, November 20, 2007

The worst resus I ever saw...

... was at a clinic ill equipped to handle a resus. Why you may ask? Because this particular clinic treated only HIV patients and if an HIV patient presents in a state requiring resus, it means it's already too late.

But on this particular day, a patient presented with huge glands in the neck (most likely due to tuberculosis - TB) which caused obstruction of his airway. He was basically dead already (FUBAR, BNDY). He still had a weak pulse and was only barely breathing but he was completely unresponsive and his pupils were dilated and very nearly fixed. His treating doctor decided that if he was intubated (a tube put into his airway so that his breathing can be assisted) and started on TB treatment, his chances of survival would be good. I was thought that it was probably already too late, but that she might as well go for it. So she sent for the resus bag (most hospitals and clinics have a resus trolley, which is a cart containing equipment and drugs needed to resuscitate a patient and is set up in the emergency room. In a hospital, one is also held at the nurses station in each ward. This clinic did not have one. This clinic had a bag containing some equipment necessary for a resus and it was kept in the back of the pharmacy somewhere). In the resus bag there were endo-tracheal tubes and even a laryngoscope but no ambu-bag (used to assist breathing when a patient can't breathe for themeselves - attached to a face mask or breathing tube). The room did have an oxygen cylinder though. For the non-medical readers suffice it to say that all this was not ideal to resuscitate a patient.

The intubation failed, so the doctor decided to go for a nasal intubation (we usually pass the tube through the mouth into the airway but it can be done through the nose). However, this also proved unsuccessful and when she pulled the tube out it was covered in thick mucus, blood and secretions. So she decided to suction. Only there was no suction. She then remarked that they had ordered suction a while ago and that it should be in the pharmacy. So someone was sent to the pharmacy. I meanwhile stood staring at all this in amazement. Then I was called for something else, so I left. I went back about ten minutes later to find the patient still lying there gargling loudly, barely breathing (I think) and the other doctor, medical student, a nurse and some auxillary staff trying to set up the suction! They couldn't get it to work. Then someone remarked that there was another suction machine. So they decided to pack the first one up and get the other one. At this point I left again. I couldn't believe all this madness.

A few minutes later someone came to say that the other doctor had called for me. When I got there, she had managed to get the suction to work and it looked as if she had suctioned most of the patient's lungs out! Seriously, there were chunks of tissue coming out and it looked like what was left of his lungs.

Then, not only did he start blinking, he also started flexing. I kid you not. He was breathing spontaneously and his Glascow scale went up a good few points. So she put him on face mask oxygen and called an ambulance to take him to the hospital. I am not even making this up.


make mine trauma said...

Unbelievable. People (patients)who whine about the health care here in the U.S. should realize just how good they have it.

Amanzi Down Under said...

Most resus stories end with:
"...and then the patient died."

Bongi said...

souldn't you say fubar bndy slmfyoyo?

down under, a friend of mine and i wanted to write a book entitled "and then she/he died".

it would have been a thick book.

amanzimtoti said...

Yes, but we didn't leave the mfoho.

Anonymous said...

OK, not to stand up for the group of people fumbling with a suction machine while the patient aspirates his way to asystole, but.. we've all walked into codes or been running codes and sometimes it takes a fresh perspective/comment on the situation to focus on what's really wrong and should be done.